Chapter 53: Assessment of Kidney and Urinary Function

An appropriate nursing intervention for the client following a nuclear scan of the kidney is to: a) Encourage high fluid intake. b) Apply moist heat to the flank area. c) Strain all urine for 48 hours. d) Monitor for hematuria.

a) Encourage high fluid intake. A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope. Monitoring for hematuria, applying heat, and straining urine do not address the potential renal complications associated with the radioisotope.

When the bladder contains 350 mL or more of urine, this is referred to as which of the following? a) Functional capacity b) Renal clearance c) Specific gravity d) Anuria

a) Functional capacity A marked sense of fullness and discomfort, with a strong desire to void, usually occurs when the bladder contains 350 mL or more of urine, referred to as the "functional capacity." Anuria is a total urine output of less than 50 mL in 24 hours. Specific gravity reflects the weight of particles dissolved in the urine. Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.

A patient is having an MAG3 renogram and is informed that radioactive material will be injected to determine kidney function. What should the nurse instruct the patient to do during the procedure? a) Lie still on the table for approximately 35 minutes. b) Take deep breaths and hold them at various times throughout the procedure. c) Drink contrast material at various intervals during the procedure. d) Turn from side to side to get a variety of views during the procedure.

a) Lie still on the table for approximately 35 minutes. This relatively new scan is used to further evaluate kidney function in some centers. The patient is given an injection containing a small amount of radioactive material, which will show how the kidneys are functioning. The patient needs to lie still for about 35 minutes while special cameras take images.

A nurse measures a patient's urinary output every 8 hours. The nurse weighs the importance of these results by comparing the normal 24-hour urinary output with the patient's condition and medication. The normal 24-hour output should be: a) 0.4 to 0.8 L/day b) 1 to 2 L/day c) 3.5 to 4 L/day d) 2.5 to 3 L/day

b) 1 to 2 L/day The normal output of urine every 24 hours is 800 to 1,500 mL. Refer to Table 26-1 in the text. The significance of the 24-hour result will depend on the patient's medical condition.

The nurse is caring for a client prescribed gentamicin 110 mg every 8 hours for 10 days. Which laboratory study is anticipated to monitor medication side effects? a) Blood chemistry b) BUN and serum creatinine c) Creatinine clearance test d) Urine osmolality

b) BUN and serum creatinine The client who is on a therapeutic regimen of gentamicin is ordered laboratory studies of a BUN and serum creatinine to monitor for signs of nephrotoxicity related to medication therapy. Nephrotoxicity from the use of an aminoglycoside is reversible if the medication is discontinued. The other laboratory studies do not focus on nephrotoxicity.

The health care provider ordered four tests of renal function for a patient suspected of having renal disease. Which of the four is the most sensitive indicator? a) Uric acid level b) Creatinine clearance level c) Blood urea nitrogen (BUN) d) BUN to creatinine ratio

b) Creatinine clearance level The creatinine clearance measures the volume of blood cleared of endogenous creatinine in 1 minute. This serves as a measure of the glomerular filtration rate. Therefore the creatinine clearance test is a sensitive indicator of renal disease progression.

The client is admitted to the nursing unit for a biopsy of the urinary tract tissue. When planning nursing care for the postoperative period, which nursing intervention documents the prescribed activity level? a) Ambulate the client in the hall b) Maintain the client on bedrest c) Assist the client for bathroom privileges d) Activity as tolerated

b) Maintain the client on bedrest In the postoperative period, the client remains on bed rest as the nurse assess for signs of bleeding. If the client is to be discharged on the following day, the client is to maintain limited activity for several days to avoid spontaneous bleeding.

The nephrons are the functional units of the kidney, responsible for the initial formation of urine. The nurse knows that damage to the area of the kidney where the nephrons are located will affect urine formation. Identify that area. a) Renal pelvis b) Renal cortex c) Renal medulla d) Renal papilla

b) Renal cortex The majority of nephrons (80% to 85%) are located in the renal cortex. The remaining 15% to 20% are located deeper in the cortex.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? a) 40 b) 30 c) 50 d) 20

c) 50 Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal.

The nurse analyzes a urinalysis report. He is aware that the presence of this substance in the urine indicates a blood level that exceeds the kidney's reabsorption capacity. Select the substance. a) Bicarbonate b) Sodium c) Glucose d) Creatinine

c) Glucose Glucose is usually filtered at the level of the glomerulus. It does not normally appear in the urine. Renal glycosuria occurs if the glucose in the blood exceeds the amount that is able to be reabsorbed. The other substances are normally excreted in the urine.

Approximately what percentage of blood passing through the glomeruli is filtered into the nephron? a) 20% b) 30% c) 40% d) 10%

a) 20% Under normal conditions, about 20% of the blood passing through the glomeruli is filtered into the nephron, amounting to about 180 L/day of filtrate.

The most frequent reason for admission to skilled care facilities includes which of the following? a) Stroke b) Urinary incontinence c) Congestive heart failure d) Myocardial infarction

b) Urinary incontinence Urinary incontinence is the most common reason for admission to skilled nursing facilities.

The nurse is providing instructions to the client prior to an intravenous pyelogram. Which statement by the client indicates teaching was effective? a) "I should remove all jewelry before the test." b) "I should let the staff know if I feel claustrophobic." c) "I will feel a warm sensation as the dye is injected." d) "I will need to drink all of the dye as quickly as possible."

c) "I will feel a warm sensation as the dye is injected." A contrast agent is injected into the client for an intravenous pyelogram. The client may experience a feeling of warmth, flushing of the face, or taste a seafood flavor as the contrast infuses. Jewelry does not need to be removed before the procedure. Claustrophobia is not expected.

A creatinine clearance test has been ordered. The nurse prepares to: a) Obtain a blood specimen. b) Collect the client's urine for 24 hours. c) Insert a straight catheter for a specimen. d) Obtain a clean catch urine.

b) Collect the client's urine for 24 hours. A creatinine clearance test is a 24-hour urine test and is useful in evaluating renal disease.

Retention of which electrolyte is the most life-threatening effect of renal failure? a) Calcium b) Phosphorous c) Sodium d) Potassium

d) Potassium Retention of potassium is the most life-threatening effect of renal failure.

Which of the following is an effect of aging on upper and lower urinary tract function? a) Increased GFR b) Acid-base balance c) Susceptibility to develop hypernatremia d) Increased blood flow to the kidney

c) Susceptibility to develop hypernatremia The elderly are more susceptible to develop hypernatremia. These patients typically have a decreased GFR, decreased blood flow to the kidney, and acid-base imbalances.

Enlargement of the prostate causes which of the following to occur? Select all that apply. a) Oliguria b) Frequency c) Obstruction of urine flow d) Polyuria e) Anuria

a) Oliguria b) Frequency c) Obstruction of urine flow e) Anuria Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.

Following a cystoscopy, the client has a nursing diagnosis of acute pain related to the trauma of the procedure to the urinary tract. An appropriate nursing intervention is to: a) Monitor for urinary retention. b) Administer prescribed antibiotics. c) Apply moist heat to the flank area. d) Assist with warm sitz baths.

d) Assist with warm sitz baths. Acute pain can be relieved with warm sitz baths. The nurse should monitor the client for urinary retention, which can help detect a potential cause of pain, but this nursing action does not relieve pain. Antibiotics may be prescribed to prevent infection. The pain associated with cystoscopy tends to be confined to the perineal area and lower abdomen not the flank area.

Which of the following is used to identify vesicoureteral reflux? a) IV urography b) Renal angiography c) Voiding cystourethrography d) Bladder ultrasonography

c) Voiding cystourethrography A voiding cystourethrography is used as a diagnostic tool to identify vesicoureteral reflux. An IV urography may be used as the initial assessment of various suspected urologic problems, especially lesions in the kidneys and ureters, and it provides an approximate estimate of renal function. Renal angiography is used to evaluate renal blood flow, to differentiate renal cysts from tumors, to evaluate hypertension, and preoperatively for renal transplantation.

A patient with a history of chronic renal infections is ordered a CT scan with contrast. Prior to the procedure, the nurse should complete which of the following? a) Hold the patient's iron supplement until after the diagnostic test. b) Instruct the patient to maintain a full bladder for the diagnostic test. c) Place emergency medical equipment in the procedure room. d) Keep the patient NPO 1 hour prior to the scan.

c) Place emergency medical equipment in the procedure room. For some patients, contrast agents are nephrotoxic and allergenic. Emergency equipment and medications should be available in case of an anaphylactic reaction to the contrast agent. Emergency supplies include epinephrine, corticosteroids, vasopressors, oxygen, and airway and suction equipment. The patient is instructed to maintain a full bladder for an ultrasonography. The other instructions/interventions relate to an MRI.

The nurse is educating a patient about preparation for an IV urography. What should the nurse be sure to include in the preparation instructions? a) The patient will have enemas until the urine is clear. b) The patient is restricted from eating or drinking from midnight until after the test. c) The patient may have liquids before the test. d) A liquid restriction for 8 to 10 hours before the test is required

c) The patient may have liquids before the test. IV urography may be used as the initial assessment of many suspected urologic conditions, especially lesions in the kidneys and ureters. The patient preparation is the same as for excretory urography, except fluids are not restricted.

Nephrotoxicity can occur as a result of the use of aminoglycosides such as gentamicin. Select all of the following statements which are true. a) Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. b) Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. c) All statements are true. d) Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.

Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear. Aminoglycosides can result in increased levels of BUN and serum creatinine, indicating nephrotoxicity. Signs of nephrotoxicity may not occur until the client has received 5 or more days of therapy. Nephrotoxicity from the use of the aminoglycosides is reversible if the drug is discontinued as soon as the symptoms appear.

Serum sodium plays a major role in maintaining fluid and electrolyte balance. Choose all the correct statements that apply. a) Aldosterone causes renal reabsorption of sodium. b) About 45% of sodium in the renal filtrate is absorbed. c) The normal serum sodium level is 90 to 120 mmol/L. d) Angiotensin II controls the release of aldosterone. e) Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration.

a) Aldosterone causes renal reabsorption of sodium. d) Angiotensin II controls the release of aldosterone. e) Renin, an enzyme released by the kidneys, activates the RAS system to ensure adequate filtration. The renin-angiotensin system (RAS) maintains the balance of fluid volume. Refer to Figure 26-4 in the text.

A 32-year-old client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography and you are in the midst of completing client education about the procedure and postprocedural assessments. What postprocedural assessment will you perform on the client? a) All options are correct. b) Palpate pedal pulses. c) Monitor site condition. d) Hypersensitivity response

a) All options are correct. After the procedure, the physician applies a pressure dressing to the femoral area, which remains in place for several hours. The nurse palpates the pulses in the legs and feet at least every 1 to 2 hours for signs of arterial occlusion. Monitoring the pressure dressing is important to note frank bleeding or hematoma formation. If either condition occurs, the nurse immediately notifies the physician. Another important assessment is for hypersensitivity responses to contrast material. The client remains on bed rest for 4 to 8 hours. The nurse also monitors and documents intake and output.

A nurse is preparing an education program about renal disease. Which risk factor should the nurse include when teaching? Select all that apply. a) Immobility b) Spinal cord injury c) Sickle-cell anemia d) Seizures e) Hypotension

a) Immobility b) Spinal cord injury c) Sickle-cell anemia Risk factors for renal disease include immobility, sickle-cell anemia, and spinal cord injury. Immobility promotes kidney stone formation. Sickle-cell anemia increases the risk for chronic kidney disease. Spinal cord injury can lead to neurogenic bladder, urinary tract infection, and urinary incontinence.

To obtain information about the chief complaint and medical history of an older male patient, the nurse asks the patient about his medication history. What is the importance of obtaining a medication history? a) It may indicate multiple medications administered by the patient. b) It may indicate drugs that should not be prescribed to the patient. c) It may reflect the patient's childhood and family illnesses. d) It may indicate the patient's general health.

a) It may indicate multiple medications administered by the patient. The nurse should obtain information about a patient's medication history because older patients, in particular, may be taking multiple medications that may affect their renal function. The medication history in general indicates the probable risk factors of renal or urologic disorders. The medication history of an older patient is not used to obtain information about the patient's general health, childhood and family illnesses, or drugs that are restricted to the patient.

The nurse is caring for a patient complaining of orange-colored urine. The nurse suspects which of the following as the cause of the urine discoloration? a) Pyridium (phenazopyridium HCl) b) Infection c) Metronidazole (Flagyl) d) Phenytoin (Dilantin)

a) Pyridium (phenazopyridium HCl) Orange to amber-colored urine is caused by concentrated urine due to dehydration, fever, bile, excess bilirubin or carotene, and the medications Pyridium (phenazopyridium HCl) and nitrofurantoin (Furadantin). Infection would cause yellow to milky white urine. Phenytoin (Dilantin) would cause the urine to become pink to red in color. Metronidazole (Flagyl) would cause the urine to become brown to black in color.

A 30-year-old male patient presents to the clinic for an employment physical. The nurse notes protein in the patient's urine. The nurse understands that transient proteinuria can be caused by which of the following? Select all that apply. a) Strenuous exercise b) Prolonged standing c) NSAIDs d) Diabetes mellitus e) Fever

a) Strenuous exercise b) Prolonged standing e) Fever Proteinuria may be a benign finding, or it may signify serious disease. Common benign causes of transient proteinuria are fever, strenuous exercise, and prolonged standing. Causes of persistent proteinuria include glomerular diseases, malignancies, collagen diseases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals, and use of medications, such as drugs, NSAIDs, and angiotensin-converting enzyme (ACE) inhibitors.

The nurse is assessing a patient upon admission to the hospital. What significant nursing assessment data is relevant to renal function? (Select all that apply.) a) The patient's occupation b) The patient's financial status c) The ability of the patient to manage activities of daily living d) Any voiding disorders e) The presence of hypertension or diabetes

a) The patient's occupation d) Any voiding disorders e) The presence of hypertension or diabetes When obtaining the health history, the nurse should inquire about the following: dysuria (painful or difficult urination), as well as when during voiding (i.e., at initiation or at termination of voiding) this occurs; occupational, recreational, or environmental exposure to chemicals (plastics, pitch, tar, rubber); hypertension; or diabetes.

The term used to describe total urine output of less than 400 mL in 24 hours is a) oliguria. b) nocturia. c) dysuria. d) anuria.

a) oliguria. Oliguria is associated with acute and chronic renal failure. Anuria is used to describe total urine output of less than 50 mL in 24 hours. Nocturia refers to awakening at night to urinate. Dysuria refers to painful or difficult urination.

A client asks the nurse why a creatinine clearance test is accurate. The nurse is most correct to reply which of the following? a) "Creatinine is found in the urine to make the urine acidic and can be measured." b) "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." c) "Creatinine is a stress-related response that is excreted by the kidney." d) "Creatinine is metabolized in the liver and excreted by the kidney at a regular rate."

b) "Creatinine is broken down at a constant rate, and the total amount is excreted by the kidney." A creatinine clearance test is used to determine kidney function and creatinine excretion. Creatinine results from a breakdown of phosphocreatine. It is filtered by the glomeruli and excreted at a consistent rate by the kidney.

A female patient presents to the health clinical for a routine physical examination. The nurse observes that the patient's urine is bright yellow in color. Which of the following questions is most appropriate for the nurse to ask the patient? a) "Do you take phenytoin (Dilantin) daily?" b) "Do you take multiple vitamin preparations?" c) "Have you noticed any vaginal bleeding?" d) "Have you had a recent urinary tract infection?"

b) "Do you take multiple vitamin preparations?" Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation. Urine that is orange may be caused by intake of Dilantin or other medications. Orange- to amber-colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Yellow to milky white urine may indicate infection, pyuria, or, in the female patient, the use of vaginal creams.

A patient is being seen in the clinic for possible kidney disease. What major sensitive indicator of kidney disease does the nurse anticipate the patient will be tested for? a) Uric acid level b) Creatinine clearance level c) Blood urea nitrogen level d) Serum potassium level

b) Creatinine clearance level Creatinine is an endogenous waste product of skeletal muscle that is filtered at the glomerulus, passed through the tubules with minimal change, and excreted in the urine. Hence, creatinine clearance is a good measure of the glomerular filtration rate (GFR), the amount of plasma filtered through the glomeruli per unit of time. Creatinine clearance is the best approximation of renal function. As renal function declines, both creatinine clearance and renal clearance (the ability to excrete solutes) decrease.

Which statement by the client preparing for a voiding cystourethrography indicates further teaching by the nurse is needed? a) "My bladder will be filled with dye using a urinary catheter." b) "Pictures will be taken of my bladder as I urinate, using ultrasound." c) "The dye is injected through an IV." d) "I will need to drink all of the dye as quickly as possible."

c) "The dye is injected through an IV." A contrast agent is instilled into the bladder through a urinary catheter. Fluroroscopy is used to examine the lower urinary tract.

A patient has a history of multiple urinary tract infections. The nurse catheterized the patient and confirmed the presence of residual urine. Select the urine volume that is significantly associated with the risk of infection. a) 100 mL b) 50 mL c) 150 mL d) 25 mL

c) 150 mL Residual urine volume of more than 100 mL is significantly associated with the risk of infection. Amounts of less than 100 are within a normal range.

The nurse is caring for a patient with a medical history of sickle cell anemia. The nurse understands this predisposes the patient to which of the following possible renal or urologic disorders? a) Kidney stone formation b) Neurogenic bladder c) Chronic kidney disease d) Proteinuria

c) Chronic kidney disease A medical history of sickle cell anemia predisposes the patient to the development of chronic kidney disease. The other disorders are not associated with the development of sickle cell anemia.

A client develops decreased renal function and requires a change in antibiotic dosage. On which factor should the physician base the dosage change? a) Liver function studies b) Therapeutic index c) Creatinine clearance d) GI absorption rate

c) Creatinine clearance The physician should base changes to antibiotic dosages on creatinine clearance test results, which gauge the kidney's glomerular filtration rate; this factor is important because most drugs are excreted at least partially by the kidneys. The GI absorption rate, therapeutic index, and liver function studies don't help determine dosage change in a client with decreased renal function.

A client has undergone diagnostic testing that involved the insertion of a lighted tube with a telescopic lens. The nurse identifies this test as which of the following? a) Renal angiography b) Excretory urogram c) Cystoscopy d) Intravenous pyelography

c) Cystoscopy Cystoscopy is the visual examination of the inside of the bladder using an instrument called a cystoscope, a lighted tube with a telescopic lens. Renal angiography involves the passage of a catheter up the femoral artery into the aorta to the level of the renal vessels. Intravenous pyelography or excretory urography is a radiologic study that involves the use of a contrast medium to evaluate the kidneys' ability to excrete it.

The nurse is preparing the client for magnetic resonance imaging (MRI) of the kidney. Which statement by the client requires action by the nurse? a) "I had my last cigarette 3 hours ago with my morning coffee." b) "I do not have a pacemaker, artificial heart valve, or artificial joints." c) "I did not take my multivitamin this morning." d) "I took my blood pressure medication with my morning coffee an hour ago."

d) "I took my blood pressure medication with my morning coffee an hour ago." The client should not eat for at least 1 hour before an MRI. Alcohol, caffeine-containing beverages, and smoking should be avoided for at least 2 hours before an MRI. The client can take his or her usual medications except for iron supplements prior to the procedure.

A client is scheduled for a renal ultrasound. Which of the following would the nurse include when explaining this procedure to the client? a) "A contrast medium will be used to help see the structures better." b) "You'll have a pressure dressing on your groin after the test." c) "An x-ray will be done to view your kidneys, ureters, and bladder." d) "You don't need to do any fasting before this noninvasive test."

d) "You don't need to do any fasting before this noninvasive test." Renal ultrasonography identifies the kidney's shape, size, location, collecting systems, and adjacent tissues. It is not invasive, does not require the injection of a radiopaque dye, and does not require fasting or bowel preparation. An x-ray of the abdomen to view the kidneys, ureters, and bladder is called a KUB. A contrast medium is used for computed tomography of the abdomen and pelvis. A pressure dressing is applied to the groin after a renal arteriogram.

A 24-hour urine collection is scheduled to begin at 8:00 am. When should the nurse initiate the procedure? a) With the first specimen voided after 8:00 am b) At 8:00 am, with or without a specimen c) 6 hours after the urine is discarded d) After discarding the 8:00 am specimen

d) After discarding the 8:00 am specimen A 24-hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. The client is initially instructed to void and discard the urine. The collection bottle is marked with the time the client voided. Thereafter, all the urine is collected for the entire 24 hours. The last urine is voided at the same time the test originally began.

A patient is having a problem with retention of urine in the bladder. Which of the following diagnostic tests measures the amount of residual urine in the bladder? a) IV urography b) Nuclear scan c) Cystography d) Bladder ultrasonography

d) Bladder ultrasonography A bladder ultrasonography is a noninvasive method of measuring urine volume in the bladder; automatic calculations display the urine volume. A nuclear scan provides information about kidney perfusion and function. It is used to evaluate acute and chronic renal failure. Cystography aids in evaluating vesicourethral reflux and in assessing bladder injury. IV urography provides an approximate estimate of renal function and may be used as the initial assessment of many urologic problems.

The nurse observes the patient's urine to be orange. Which additional assessment would be important for this patient? a) Bleeding b) Intake of multiple vitamin preparations c) Infection d) Intake of medication such as phenytoin (Dilantin)

d) Intake of medication such as phenytoin (Dilantin) Urine that is orange may be caused by intake of Dilantin or other medications. Orange to amber colored urine may also indicate concentrated urine due to dehydration or fever. Urine that is pink to red may indicate lower urinary tract bleeding. Urine that is bright yellow is an anticipated abnormal finding in the patient taking a multiple vitamin preparation. Yellow to milky white urine may indicate infection, pyuria, or in the female patient, the use of vaginal creams.

The wall of the bladder has four layers. Which of the following layers contains a membrane that prevents reabsorption of urine stored in the bladder? a) Detrusor b) Connective tissue c) Adventitia d) Mucosal

d) Mucosal Beneath the detrusor is a submucosal layer of loose connective tissue that serves as an interface between the detrusor and the innermost layer, a mucosal lining. This inner layer contains specialized transitional cell epithelium, a membrane that is impermeable to water and prevents reabsorption of urine stored in the bladder.

A client in a short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a) keep the client's knee on the affected side bent for 6 hours. b) remove the dressing on the puncture site after vital signs stabilize. c) apply pressure to the puncture site for 30 minutes. d) check the client's pedal pulses frequently.

d) check the client's pedal pulses frequently. After renal angiography involving a femoral puncture site, the nurse should check the client's pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the client's knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse should leave this dressing in place for several hours — and only remove it if instructed to do so.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: a) childhood asthma. b) chronic, excessive acetaminophen use. c) family history of pernicious anemia. d) recent streptococcal infection.

d) recent streptococcal infection. A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.