Patho #3

A new client on hemodialysis is watching his blood being filtered through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds:

1000-1300 mL/minute.

Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:

20 mg/dL (7.14 mmol/L)

The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?

22%-25%

Absorption is a major function of the GI tract. How is absorption accomplished in the GI tract?

Active transport and diffusion

A 79-year-old woman reports a recent onset of "nearly constant heartburn." During the assessment interview, she states that she has "lots of aches and pains." She states that she is not on any prescription medications but often takes aspirin for pain. The nurse should suspect what diagnosis?

Acute gastritis

A 79-year-old woman reports a recent onset of "nearly constant heartburn." During the assessment interview, she states that she has "lots of aches and pains." She states that she is not on any prescription medications but often takes aspirin for pain. The nurse should suspect what diagnosis?

Acute gastritis Aspirin is often implicated in cases of acute gastritis. H. pylori, gastric cancer, and staphylococcus infections do not normally cause reflux (heartburn) and are not directly linked to aspirin use.

An older adult client presents with loose mucus-filled stools. The nurse suspects the client has Clostridium difficile. What is a priority assessment for the nurse?

Ask the client about his or her antibiotic use.

Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure?

Azotemia and a decrease in the GFR

An adult has a serum sample taken to evaluate the BUN-creatinine ratio. Select the result that indicates a normal test.

BUN 10 mg/dL (3.57 mmol/L) to creatinine 1 mg/dL (88.40 µmol/L)

Diverticulitis is the herniation of tissue of the large intestine through the muscularis layer of the colon. It is often asymptomatic and is found in approximately 80% of people over the age of 85. Diverticulitis is often asymptomatic, but when symptoms do occur, what is the most common complaint of the client?

Lower left quadrant pain with nausea and vomiting

The nurse is providing discharge instructions to an older adult client with diverticular disease. Which recommendations should the nurse include?

Increase whole grains Increase fruits Increase vegetables

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

Increased blood pressure

The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function?

Increased creatinine and blood urea nitrogen (BUN) levels

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

The nurse caring for a client with diverticulitis should assess for which clinical manifestation?

Lower left quadrant pain

The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis Pharmacologic agents that are directly toxic to the renal tubule include aminoglycosides (e.g., gentamicin), chemotherapeutic agents such as cisplatin and ifosfamide, and radiocontrast agents. Nephrotoxic agents cause tubular injury by inducing varying combinations of renal vasoconstriction, direct tubular damage, or intratubular obstruction. Postrenal failure results from obstruction of outflow of the kidneys. CKD and its treatment can interfere with the absorption, distribution, and elimination of drugs. Acute tubular necrosis (ATN) occurs most frequently in clients who have major trauma, severe hypovolemia, overwhelming sepsis, trauma, or burns.

One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is exceeded, excess fatty acids accumulate in the liver. To what disease do these excess fatty acids contribute?

Nonalcoholic fatty liver disease

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?

Obstruction of the renal tubules with myoglobin and damaged tubular cells

Surgical stone removal is indicated for which instance?

Obstruction of urine flow

A nurse is reviewing the mechanisms of action of diuretics. Which diuretic is the most effective?

Loop diuretics

The client has just been diagnosed with bladder cancer and asks the nurse what causes it. What would be the nurse's best response to the client?

"The cause is unknown."

Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?

Extracorporeal shock wave lithotripsy (ESWL)

A client has undergone a kidney transplant and voices concerns about organ rejection to the nurse. The most appropriate response by the nurse would be:

"You will be given medication to decrease the likelihood of your immune system attacking your new kidney."

A mother asks, "Why can't my 1-year-old go to the bathroom by himself?" What is the nurse's best response?

"Your child is too young to begin toilet training."

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds:

"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."

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 nursing instructor who is teaching about incontinence in older adults recognizes a need for further instruction when a student makes which statement?

"Frequency is not a major problem for the elderly."

Antibody testing has confirmed that a client is positive for hepatitis A virus (HAV). Which statement suggests the client understands the new diagnosis?

"I don't know why I didn't bother to get vaccinated against this."

A neighbor is complaining to a friend (who happens to be a nurse) about several changes in her body. Which of the following complaints raises a "red flag" because it could be a sign of epithelial cell bladder cancer?

"I noticed my urine is pinkish red, but I'm not having any pain when I pee."

A middle-aged adult is diagnosed with diverticular disease based on recent history and the results of a computed tomography (CT) scan. Which statement demonstrates an accurate understanding of this diagnosis?

"I suppose I should try to eat a bit more fiber in my diet."

A client with a recent diagnosis of renal failure requiring hemodialysis is being educated in the dietary management of the disease. Which statement by the client shows an accurate understanding of this component of treatment?

"I'll increase the carbohydrates in my diet to provide sufficient energy." "I've made a list of high-phosphate foods so that I can try to avoid them."

A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?

"I'm feeling a bit under the weather these days and I'm a bit feverish."

Which statement would help a nurse best explain an "incretin effect"?

"It is an increase in insulin release after ingestion of food."

A student presents to the campus clinic with reports of frequent, burning urination and is diagnosed with an acute lower urinary tract infection (UTI) caused by Escherichia coli. What teaching will the health care provider most likely provide to the student?

"Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe."

Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer?

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

A client in the hospital is frustrated at the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine-collection test. The client asks the nurse why the test is necessary since the client provided a single urine sample 2 days prior. How could the nurse best respond?

"Often when an abnormal substance shows up in a urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."

A student is comparing the two patterns of contractions in the small intestine. Which statement is most accurate?

"Segmentation waves function mainly to mix the chyme with the digestive enzymes from the pancreas."

In anatomy class, the instructor asks, "Explain how urine is expelled from the bladder during voiding." Which student has given the most accurate response?

"The detrusor muscle contracts down on the urine and the ureteral orifices are forced shut. The external sphincter relaxes as urine moves out of the bladder."

A nurse is teaching a client scheduled for a cystoscopy about the procedure. Which statement made by the client verifies that the teaching has been successful?

"The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder."

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

The client who has just been diagnosed with bladder cancer asks the nurse what treatment he will have to undergo. What would be the nurse's best response to this question?

"The methods used depend on the grade of the tumor and the lesion's invasiveness."

A student is studying the esophagus. Which statement made by this student to a faculty member is a correct one?

"The smooth muscle layers provide the peristaltic movements needed to move food along the length of the esophagus."

A client who ate a large meal and then went to weightlifting class states "feeling very uncomfortable" and reports gastric reflux. What is the nurse's best response to the client?

"There is backward movement of gastric contents into the esophagus that occurs soon after eating."

A student asks the nurse preceptor about a laboratory test called interleukin (IL)-18. Which statement by the nurse will assist the student in providing better care to clients with acute kidney injuries (AKI)?

"This is an inflammatory cytokine which is an early marker for ischemic AKI in the proximal tubule."

A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client?

"This value indicates you are having difficulty emptying your bladder."

The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?

"Your loved one may not look ill, but the virus is present in his blood."

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

Catheter-associated bacteriuria

A client is suspected to have chronic kidney disease (CKD). The nurse will use which glomerular filtration rate (GFR) to aid in this diagnosis?

60 mL/min/1.73 m2 or less for 3 months

What percentage of stool is water?

75

In women, stress incontinence is a common problem. The loss of the angle between the urethrovesical junction and the bladder contributes to stress incontinence. What is the normal angle between the bladder and the urethrovesical junction?

90 to 100 degrees

Select the client at greatest risk for developing colorectal cancer.

A 64-year-old female whose mother had colorectal cancer

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years.

A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?

A BUN to creatinine level ratio of 20:1

A client who has developed rheumatoid arthritis can experience joint inflammation that involves of immunologic mediation triggered by which physiologic response?

A T-cell-mediated response to an immunologic trigger, such as a microbial agent

Which client likely faces the greatest risk of a gastrointestinal bleed?

A client who takes aspirin with each meal to control symptoms of osteoarthritis

The nurse is reviewing the medical history of four clients. The nurse determines that the client at greatest risk for developing peptic ulcer disease is:

A client with a prior diagnosis of Helicobacter pylori and refused treatment The two most important risk factors for peptic ulcer disease are infection with the bacteria H. pylori and use of aspirin and/or NSAIDs. Acetaminophen does not place the client at risk for liver injury. A history of a ruptured appendix will not cause peptic ulcer. The high fat intake may contribute to the development of atherosclerosis.

Which client is benefiting from the renin-angiotensin-aldosterone mechanism?

A college student admitted to the neurotrauma unit following traumatic brain injury requiring surgery to evacuate a large hematoma The kidney releases renin, which enters the blood stream to convert angiotensinogen to angiotensin I. The angiotensin I travels to the lungs, where it is converted to angiotensin II. Angiotensin II acts directly on the kidneys. Renin functions by means of angiotensin II to produce intrarenal vasoconstriction. This helps to regulate blood pressure, which could be a problem for the client having bleeding (hematoma) inside the brain.

The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client?

A daily fluid intake of 500 to 800 mL/day to maintain hydration

A nurse suspects a diagnosis of Goodpasture syndrome for which client?

A middle-aged male who works as a painter Goodpasture syndrome is an uncommon and aggressive form of glomerulonephritis that is caused by antibodies to the glomerular basement membrane. The cause of the disorder is unknown, although influenza infection and exposure to hydrocarbon solvent (found in paints and dyes) have been implicated in some persons, as have various drugs and cancers.

In which client would the nurse recognize the symptoms of a lesion in the micturition center of the sacral cord?

A trauma client whose bladder ultrasound reveals 1140 mL of urine

A nurse caring for a client with an intestinal obstruction anticipates which assessment findings? Select all that apply.

Abdominal pain Abdominal distension Vomiting

A client asks the nurse what may have caused elevation in urinary protein levels (proteinuria) on a urine test. The best response by the nurse would be:

Abnormal glomerular filtration

A client has begun to display manifestations of hepatic encephalopathy. The family is concerned and asks the nurse what caused this condition to develop. Which is the best response by the nurse?

Accumulation of ammonia in the blood

A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this?

Acetaminophen

In addition to regulating body fluids and electrolytes, the kidneys' endocrine function in maintaining bone calcium levels consists of what process?

Activating vitamin D

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 Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations.

A client who developed acute pyelonephritis asks the nurse what caused the infection. What should be included in the nurse's response?

Acute pyelonephritis is caused by bacterial infection. Escherichia coli is the causative agent in about 80% of cases. Outflow obstruction, catheterization, and urinary instrumentation

The nurse is caring for a client with viral hepatitis who has general malaise, easy fatigability, arthralgia, and anorexia. These manifestations correspond with what stage of the disease?

Acute symptomatic viral hepatitis can be divided into three phases: the prodromal period, icterus phase, and the convalescent phase. The prodromal period includes general malaise, myalgia, arthralgia, easy fatigability, and severe anorexia. There may also be nausea, vomiting, and diarrhea with mild, right-sided abdominal pain. The icterus phase usually follows the first phase by 5 to 10 days. Jaundice may accompany a temporary worsening of the initial symptoms. In the convalescent phase the client begins to feel better, regains the appetite, and jaundice subsides. The acute illness subsides gradually over 2 to 3 weeks.

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication?

Acute tubular necrosis Complications of acute pancreatitis include the systemic inflammatory response, acute respiratory distress syndrome, acute tubular necrosis, and organ failure. Cerebral hemorrhage, bilateral pneumothorax, and complete heart block are not associated with the complications of acute pancreatitis.

The nurse caring for a client with bleeding esophageal varices should anticipate which interventions being prescribed?

Administering vasopressin Assisting with placement of a balloon tamponade Octreotide

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

Albumin The clinical manifestations of diabetic glomerulosclerosis are closely linked to those of diabetes. The increased glomerular filtration rate that occurs in people with early alterations in renal function is associated with microalbuminuria, which is defined as urinary albumin excretion of 30 to 300 mg in 24 hours.

The nurse is teaching a group of nursing students about alcohol-induced liver disease and the cytochrome P450 system (CYP P450). Which of these is correct for the nurse to include in the lesson?

Alcohol consumption enhances susceptibility to effects of drugs and toxins.

The nurse is caring for a college student with infectious mononucleosis. For which reason does the nurse teach the client to abstain from alcohol during the acute phase of the disease?

Alcohol may worsen a mild hepatitis which occurs in the acute phase.

What could cause a client to develop a partial obstruction of the sphincter of the pancreas confirmed by X-ray?

Alcoholic beverages

Which statement accurately describes the etiology of stress incontinence?

An increase in intra-abdominal pressure that results in involuntary urination

Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?

Anemia

A client with rheumatoid arthritis (RA) tells the nurse that the disease-modifying antirheumatic drug (DMARD) methotrexate does not seem to be working anymore. Which other antirheumatic medication category can the nurse relay that may be prescribed following DMARD failure?

Anti-TNFs like infliximab Other first-line antirheumatic drugs include biologics such as anti-TNFs like etanercept, infliximab, and adalimumab, and non-TNFs such as abatacept, rituximab and tocilizumab.

The nurse is caring for a client who is concerned he may have contracted hepatitis C from a sexual partner. Which of these is it correct for the nurse to teach the client about this disease?

Antibodies may be detected in the blood in 6 to 8 weeks.

Which type of pharmacologic therapy does the nurse anticipate administering to a client for treatment of a spastic bladder in order to decrease bladder hyperactivity?

Anticholinergic medications

A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?

Antihypertensive medications

A nurse is reviewing the admission assessment data of a client diagnosed with acute gastritis. The nurse determines that the condition most likely occurred as a result of:

Arthritis treated with high levels of nonsteroidal anti-inflammatory (NSAIDs) agents

A client with type 1 diabetes mellitus has bladder atony with dysfunction. Which assessment indicates a primary concern for this client?

Ascending urinary tract infection

A client has experienced a stroke affecting the reticular formation of the medulla and lower pons. The nurse tells the client's wife that care must be taken with eating to prevent:

Aspiration pneumonia Diseases (strokes) that disrupt the brain centers of the reticular formation of the medulla and lower pons disrupt the coordination of swallowing and predispose a person to food and fluid lodging in the trachea and bronchi, which leads to asphyxiation or aspiration pneumonia. The other options are not caused by damage to the brain.

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

Autosomal recessive Autosomal recessive familial PKD is characterized by cystic dilatation of the cortical and medullary collecting tubules. It is rare compared with autosomal dominant polycystic kidney disease and usually presents as severe renal dysfunction during infancy.

A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following?

Avoiding bubble baths Wiping from front to back after a bowel movement Careful hand washing

Acute pyelonephritis is a result of:

Bacterial infection

The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

The nurse is performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which area?

Between the 12th thoracic and 3rd lumbar vertebrae

The nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is:

Bladder

A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms?

Blood work for hemoglobin, red blood cells, and hematocrit

A 64-year-old female whose mother had colorectal cancer

Board-like abdomen

Which enzymes adhere to the border of the villus structures to allow access to carbohydrate and protein molecules?

Brush border

A student identifies enterocytes on a microscope slide of tissue. The student explains that these cells secrete:

Brush border enzymes

A client has developed bursitis of the right knee. Which statements related to this condition are correct?

Bursitis develops where pressure is exerted. Movement may be limited. Swelling may occur. Pain may develop.

A client diagnosed with inflammatory diarrhea is having multiple small, bloody stools with a fever. Which could be a likely cause of this inflammatory diarrhea?

C. difficile

The nurse is caring for a client with chronic renal failure who is on hemodialysis three times a week. In order to treat hyperphosphatemia and hypocalcemia, which medication will the nurse administer to decrease absorption of phosphate from the gastrointestinal tract?

Calcium carbonate

Which statement is true concerning the digestion of carbohydrates?

Carbohydrates are broken down into monosaccharides before being absorbed.

Following kidney transplantation, the client is prescribed maintenance immunosuppressive therapy consisting of prednisone, azathioprine, and cyclosporine. While educating the client about the immunosuppressive therapy, which side effects should the nurse include in the teaching plan?

Cardiovascular complications Increased risk of developing cancer Development of metabolic dysfunction

Which meal choice is most likely to exacerbate an individual's celiac disease?

Celiac disease is treated by the removal of wheat, barley, and rye from the diet, all of which contain gluten. Both spaghetti and garlic bread are wheat based and would exacerbate celiac disease. The other noted meals do not contain these grains.

When caring for the client with pancreatic cancer, for which of these signs and symptoms does the nurse assess?

Central abdominal pain, jaundice, and weight loss

A student is studying gallbladder function. Which gastrointestinal hormone stimulates contraction of the gallbladder?

Cholecystokinin Cholecystokinin, which is secreted in the duodenum and jejunum, stimulates contraction of the gallbladder and secretion of pancreatic enzymes.

When assessing the nutritional intake of a client with generalized pancreatic cancer, which statement by the client is consistent with the disease and food intake?

Client states pain becomes worse with food intake.

The nurse is assigned multiple clients with anemia. Which client may be experiencing a failure of the body to produce erythropoietin and thus may require supplemental injections of this hormone?

Client with history of chronic kidney failure

A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate?

Clients can develop signs of diabetes and malabsorption.

The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which reason?

Clients have few early symptoms of the disease.

Crohn disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which description?

Cobblestone A characteristic feature of Crohn disease is the sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. When there are multiple lesions, they are often referred to as "skip lesions" because they are interspersed between what appear to be normal segments of the bowel. The surface of the inflamed bowel usually has a characteristic "cobblestone" appearance resulting from the fissures and crevices that develop, surrounded by areas of submucosal edema.

An older adult client has been placed on a broad-spectrum antibiotic for a recurrent urinary tract infection. Which potential problem would the nurse anticipate in this client?

Colonization of Clostridium difficile

A health care provider suspects a client has developed diverticular disease. Which diagnostic test is usually prescribed to confirm the diagnosis?

Computed tomography (CT) scan

Which additional physical finding would you anticipate seeing in a child suspected of having a Wilms tumor?

Congenital anomalies, usually of the genitourinary system

The nurse is admitting a client whose medication administration record includes a weekly injection of erythropoietin (EPO). Which nursing consideration should be associated with this medication?

Consider the possibility that the client has a diagnosis of chronic renal failure.

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

An 80-year-old client with diabetes has a GFR of 41 mL/min/1.73 m2. His physical and workup show uremia, azotemia, and elevated BUN. Which action should be done first to slow the decline of his kidney function?

Control blood glucose and blood pressure The client demonstrates evidence of CKD, and early management should focus on controlling blood sugars and blood pressure to slow the loss of renal function. Protein restriction could have adverse effects and may not be sufficient to slow the loss of function. Increasing IV fluids could exacerbate his symptoms and increase blood pressure. Kidney transplant would not be the first intervention attempted.

A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs

A nurse is evaluating a client's morning laboratory values. Which result requires that the nurse notify the health care provider?

Creatinine: 10.6 mg/dL (937.04 µmol/L) A rise in the serum creatinine level to three times its normal value suggests that there is a 75% loss of renal function, and with creatinine values of 10 mg/dL or more, it can be assumed that approximately 90% of renal function has been lost.

A young man presents reporting diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect?

Crohn disease

The nurse is conducting preoperative teaching for a client with bladder cancer who is scheduled to undergo surgical creation of an alternative bladder reservoir. The nurse determines that the client is understanding the preoperative teaching when the client identifies the surgical treatment as:

Cystectomy

When the urologist wants to directly visualize the bladder, urethra, and ureteral orifices, what diagnostic test would he use?

Cytoscopy

A nursing instructor who is teaching students about urinary incontinence in older adults suggests that an easy and effective way to remember the transient and treatable causes of urinary incontinence is to use which acronym?

DIAPPERS DIAPPERS is the preferred acronym. D stands for dementia, I for infection, A for atrophic vaginitis, P for pharmaceutical agents, P for psychological causes, E for endocrine conditions, and R for restricted mobility. FACES is the acronym for the pain scale used with children. SBAR refers to method used in the hand-off report. CBC stands for a complete blood count.

A nurse is concerned about a client's continual use of nonsteroidal anti-inflammatory drugs (NSAIDs). Which problematic occurrence is the nurse concerned about?

Damage to the gastric mucosa

A client has just been admitted to the emergency department after sustaining severe injuries and massive blood loss following a motor vehicle accident. The nurse predicts that the client's glomerular filtration rate will:

Decrease

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?

Decreased albumin

The nurse is caring for a client who has sustained a cervical spinal cord injury with resulting muscle wasting due to immobility. Which alteration in the laboratory tests does the nurse recognize is consistent with decreased muscle mass?

Decreased creatinine levels

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that this client will experience which manifestations?

Decreased renal endocrine function Decreased tubular reabsorption Decreased glomerular filtration

When providing care for the client with pancreatic cancer, the nurse should observe for which of these complications?

Deep vein thrombosis Migratory thrombophlebitis (deep vein thrombosis) develops in about 10% of persons with pancreatic cancer, affecting deep veins of the legs, the subclavian vein, the inferior and superior mesentery veins, and vena cava. This may be the first evidence of pancreatic cancer and may present in other cancers as well. Hyperglycemia typically occurs in pancreatitis when the beta cells are affected. Since vomiting is a symptom of pancreatitis, fluid volume deficit is anticipated. Abdominal distention or the ARDS may lead to hypoventilation.

Excessive intestinal secretion or impaired absorption can lead to which extracellular problem?

Dehydration

Disruption of which muscle's contraction can lead to the inability to expel urine from the bladder?

Detrusor

The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents?

Developmental delay Delayed cognitive development Secondary hyperparathyroidism Growth impairment

A new client presents with elevated BUN, systemic edema, a BP of 145/93 mm Hg, recurrent infections, and a GFR of 51 mL/min/1.73 m2. Which treatment should the nurse anticipate?

Dialysis These findings are suggestive of chronic kidney disease (CKD), defined as kidney damage with a GFR less than 60 mL/min/1.73 m2 for 3 months or longer. Dialysis is a likely intervention. The disease is noninfectious, so antibiotics are not necessarily indicated. Dialysis would precede a transplant in nearly all circumstances. BMT is not a relevant intervention.

When maltose is not broken down into two glucose molecules in the gastrointestinal tract, which of the following may occur?

Diarrhea

A pathophysiology student is differentiating digestion from absorption. Which explanation is most accurate?

Digestion is the process of dismantling foods into their constituent parts.

Which aspect of gastrointestinal function is performed by the brush border enzymes of the villus structures?

Digestion of carbohydrates

The nurse teaches that viral hepatitis damages the liver by which mechanism?

Direct cellular injury There are two mechanisms of liver injury in viral hepatitis: direct hepatocellular injury and induction of immune responses against the viral antigens. Intrahepatic biliary diseases disrupt the flow of bile through the liver, causing cholestasis and biliary cirrhosis. Cholangitis involves inflammation of hepatic bile ducts. Fatty liver is characterized by the accumulation of fat in hepatocytes, a condition called steatosis.

A client who has been taking acetaminophen 1000 mg every 4 hours presents to the Urgent Care Center with increased abdominal pain, elevated ALT, AST, and bilirubin levels. The nurse suspects the client is experiencing:

Direct hepatotoxic reaction Direct hepatotoxic reactions usually are a recognized characteristic of certain drugs. They usually result from drug metabolism and the generation of toxic metabolites from drugs like acetaminophen, isoniazid, and phenytoin. The condition is characterized by elevated ALT, AST, and bilirubin. Idiosyncratic reactions are unpredictable, not related to dose, and sometimes accompanied by features suggesting an allergic reaction. Cholestatic drug reactions result in decreased secretion of bile or obstruction of the biliary tree. The clinical features of chronic hepatitis are extremely variable and not predictive of outcome.

When administering a thiazide diuretic the nurse recognizes these medications exert their effects in which area of the kidney?

Distal and collecting tubules

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?

Diuretic phase The onset phase lasts hours/days and is the time from the onset of the precipitating event until tubular injury occurs. The oliguric phase is characterized by a marked decrease in glomerular filtration rate, causing sudden retention of endogenous metabolites, such as urea, potassium, sulfate, and creatinine. The diuretic phase occurs when the kidneys try to heal and one will see an increase/excessive output (diuresis) of dilute urine. The recovery phase is the period during which tubular edema resolves and renal function improves. There is normalization of fluid and electrolyte balance.

Ascites is an accumulation of fluid in the peritoneal cavity and usually occurs in advanced cirrhosis. What is the treatment of choice for ascites?

Diuretics Because of the many limitations in sodium restriction, the use of diuretics has become the mainstay of treatment for ascites. A paracentesis may be done if the diuretics do not correct the problem. A thoracentesis would never be done for ascites. DDAVP is given to decrease urine output, not increase it.

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:

Dorsiflexion of hands and feet

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.

The client tells the nurse that she is very anxious and that her pulse is racing. What will the nurse expect to see?

Dry mouth

An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education?

Dry mouth and constipation are common.

Which dermatologic problem most often accompanies chronic kidney disease (CKD)?

Dry skin and pruritus

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain descriptors can be associated with adenocarcinomas of the pancreas?

Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward. The most common pain with pancreatic cancer is a dull, epigastric pain often accompanied by back pain, often worse in the supine position, and relieved by sitting forward. Sharp, stabbing pain with respirations could be pleurisy among other respiratory problems. Abdominal pain following a meal is usually associated with GERD or gastric ulcers. Cerebral edema causing headaches is not related to pancreatic cancer.

What is the condition that is characterized by the rapid emptying of highly acidic and hyperosmotic gastric secretions into the duodenum and jejunum?

Dumping syndrome

A client's most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (12.85 mmol/L). Which factor may have contributed to this finding?

During periods of dehydration, the blood volume and glomerular filtration rate drop, and BUN levels increase. Increased salt intake, parasympathetic stimulation, and the action of antidiuretic hormone do not normally result in an increase in BUN.

A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor this client for which gastrointestinal signs and symptoms?

Early morning nausea Gastrointestinal ulceration Metallic taste Anorexia

A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

When caring for the client with kidney failure, the nurse anticipates that which laboratory test abnormalities will be present? Select all that apply.

Elevated potassium Decreased calcium Increased creatinine

A client is admitted with chronic gastritis. The nurse expects which invasive test to be performed to establish the presence of Helicobacter pylori (H. pylori)?

Endoscopic biopsy

A nurse is caring for a client with end-stage renal failure who has symptoms of anemia. The nurse anticipates administering which intervention to increase red blood cell production?

Epoetin alfa Persons with end-stage kidney disease often are anemic because of an inability of the kidneys to produce erythropoietin. This anemia usually is managed by the administration of a recombinant erythropoietin (epoetin alfa) produced through DNA technology to stimulate erythropoiesis.

Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on:

Eradicating Helicobacter pylori (H. pylori) Treatment of peptic ulcer is aimed at eradicating the cause and promoting a permanent cure for the disease. Pharmacologic treatment focuses on eradicating H. pylori, relieving ulcer symptoms, and healing the ulcer crater. Acid-neutralizing, acid-inhibiting drugs and mucosa-protective agents are used to relieve symptoms and promote healing of the ulcer crater. There is no evidence that special diets are beneficial in treating peptic ulcer.

The nurse is caring for a client with a condition of deficiency of antidiuretic hormone (ADH). When assessing the client, which finding does the nurse anticipate?

Excessive urine output

The physiologic rationale for hanging normal saline (0.9% NS) or 5% dextrose in water (D5W) to a client who has been experiencing diarrhea includes:

Facilitating the absorption of osmotically active particles Water absorption from the intestine is linked to absorption of osmotically active particles such as glucose and sodium. It follows that an important consideration in facilitating the transport of water across the intestine (and decreasing diarrhea) after temporary disruption in bowel function is to include sodium and glucose in the fluids that are consumed. None of the other distractors addresses this principle. Activating the pancreatic enzymes of trypsin and elastase is needed for protein digestion and absorption. Emulsification of fats begins in the stomach and continues in the duodenum under the influence of bile from the liver.

A client is admitted with a diagnosis of flaccid bladder. The nurse caring for this client understands this client will exhibit which disorder of the bladder?

Failure to empty urine

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?

Fats Lack of production of bile salts causes malabsorption of fat and fat-soluble vitamins.

A teenager has been diagnosed with failure to thrive possibly due to malabsorption syndrome. In addition to having diarrhea and bloating, the client more than likely has what hallmark manifestation of malabsorption?

Fatty, yellow-gray, foul-smelling stools

A teenager who has a history of achalasia will likely complain of which clinical manifestation?

Feeling like there is food stuck in the back of the throat Achalasia produces functional obstruction of the esophagus so that food has difficulty passing into the stomach, and the esophagus above the lower esophageal sphincter becomes distended. Symptoms following high-fat intake are usually associated with gallbladder disease. Projectile vomiting is usually related to increased intracranial pressure. Vomiting blood can be associated with esophagitis, erosion of the esophagus, bleeding esophageal varices, or esophageal cancer.

A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be:

Fistula formation

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

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

Following a needlestick injury, a nurse develops hepatitis C that eventually developed into a chronic infection. The health care provider counsels the nurse to assess for which major complications that can result from this chronic condition?

Following a needlestick injury, a nurse develops hepatitis C that eventually developed into a chronic infection. The health care provider counsels the nurse to assess for which major complications that can result from this chronic condition?

A client with chronic pancreatitis is experiencing an episode of recurring epigastric pain. The dietitian knows that the client's diet should limit which type of meal to avoid further episodes?

Fried chicken and french fries

Parents of a toddler report that he often refuses food and grimaces when he swallows. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which health problem would the care team first suspect?

Gastrointestinal reflux

A student is comparing the actions of the gastrointestinal hormones. Which hormone acts as an appetite-stimulating signal?

Ghrelin

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.

Glomerular filtration rate (GFR)

When caring for the client with proteinuria, the nurse recognizes that dysfunction in which structure of the kidney allows protein to leak into the urine?

Glomerulus

A client is having radiation prior to having a pituitary tumor removed. Which loss of pituitary hormone is typically the first to be lost?

Growth hormone

Ghrelin produced in the mucosal layer of the stomach has a role in regulation of which hormone that contributes to the regulation of weight?

Growth hormone

Which manifestations will the nurse expect to find in a client with advanced liver failure?

Halitosis Hematuria Asterixis

The student is examining a wedge of compact bone tissue and its blood distribution. The spaces in the cortex that move parallel through the long axis of the bone and contain blood vessels are known as:

Haversian canals

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

Hematuria Presenting features of renal cancer include hematuria, flank pain, and presence of a palpable flank mass. Gross or microscopic hematuria, which occurs in more than 50% of cases, is an important clinical clue. Urgency, oliguria, and cloudy urine are not as closely associated with renal carcinoma.

Which signs and symptoms would you expect to see in a client diagnosed with acute nephritic syndrome?

Hematuria and proteinuria

Which diagnosis causes an increased risk of developing intrahepatic jaundice?

Hepatitis Cirrhosis Liver cancer

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis?

High serum amylase and lipase Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin levels may indicate liver disease. Alkaline phosphatase is one kind of enzyme found in the body. It can show signs of liver disease or a bone disorder. The red blood cell count is used to measure the number of oxygen-carrying blood cells in a volume of blood. Chymotrypsin digests proteins in the intestine. Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. Prothrombin time is a blood test that measures how long it takes blood to clot.

A mixed martial arts fighter takes a strong punch to the nose. As a result, the nose "breaks." What is the etiology of the client's injury?

Hyaline cartilage has been disrupted Hyaline cartilage is the major portion of the nose, and when the nose is broken, it's the cartilage that breaks. Elastic cartilage is flexible, as in the ear. Fibrocartilage is found in the intervertebral disks and where tendons connect to bones.

In Addison disease, the majority of the adrenal cortex has been destroyed. This causes a lack of mineralocorticoids and glucocorticoids. Therapy consists of oral replacement with what drug?

Hydrocortisone

Which substance can be eliminated from the body by the kidneys as a means of regulating body acid-base balance when urine buffers are present?

Hydrogen (H+) Only the kidneys can eliminate hydrogen from the body. When urine buffers are present, bicarbonate (HCO3), phosphate (HPO4), and ammonia (NH3) can combine with H+. Changes in potassium level can be the cause or result of a pH change.

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely?

Hydronephrosis Hydronephrosis refers to urine-filled dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction of urine outflow.

The nurse is caring for a client with right upper quadrant pain secondary to acute choledocholithiasis. If the common bile duct becomes obstructed, which manifestation will the nurse expect?

Hyperbilirubinemia Choledocholithiasis, stones in the common duct, usually originate in the gallbladder but can form spontaneously in the common duct. Bilirubinuria and an elevated serum bilirubin (hyperbilirubinemia) are present if the common duct is obstructed. With acute cholecystitis, approximately 75% of clients have vomiting. Ascites is common with late-stage liver failure rather than duct obstructions. Bleeding is associated with liver failure due to deficiency of clotting factors, and is also associated with acute pancreatitis due to activated enzymes causing fat necrosis and hemorrhage from the necrotic vessels.

Disorders of phosphate and calcium metabolism frequently occur in clients with chronic kidney disease (CKD). The nurse recognizes which statement regarding phosphate and calcium imbalances is correct?

Hypercalcemia can lead to osteodystrophy of CKD, which predisposes clients to cardiovascular disorders.

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication?

Hyperglycemia due to inability to synthesize insulin

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

Which conditions have the potential to cause chronic kidney disease?

Hypertension Diabetes Glomerulonephritis

A 30-year-old client has been diagnosed with ankylosing spondylitis. Which etiology is responsible for this health problem?

Immune response

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice?

Impaired uptake of bilirubin

The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. What is the most appropriate response by the nurse?

In renal disease, vitamin D is unable to be transformed to its active form.

During assessment of a recently admitted client with right-sided heart failure, the nurse notes that the liver is enlarged and verifies by palpation and percussion. A student asks the nurse to explain how the liver and heart failure are related. Which is the nurse's best response?

In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver.

The swallowing reflex is an ordered sequence of events. In which phase is the epiglottis moved so that it covers the larynx?

In the pharyngeal phase, which is involuntary, the vocal cords are pulled together and the epiglottis is moved so that it covers the larynx.

A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis?

Incontinence related to neuropathy causing overactive bladder

The nurse is caring for a client with alcoholism who now presents with gastrointestinal bleeding. What alteration does the nurse anticipate related to the bleeding?

Increase in ammonia level Intestinal production of ammonia is increased after ingestion of high protein foods and gastrointestinal bleeding. In advanced liver disease, urea synthesis often is impaired, leading to an accumulation of blood ammonia. Elevated prothrombin times means it takes longer for the blood to clot (17 seconds, for example). This usually happens because the liver is not making the right amount of blood clotting proteins, so the clotting process takes longer.

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally

A client is newly diagnosed with irritable bowel syndrome (IBS). The nurse explains how the nervous system affects gastrointestinal (GI) disorders. The nurse mentions which statement in regard to IBS?

Increase in parasympathetic nervous system activity

Albuminuria is an important indicator of nephron damage. The nurse recognizes that which statements regarding albuminuria are correct?

Increased excretion of albumin indicates CKD. Urine dipstick can detect albuminuria. Albumin-to-creatinine ratio can confirm albuminuria.

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which measures should the client integrate into his or her lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes

When caring for the client with hepatic failure, the nurse recognizes that which problem places the client at increased risk for bleeding?

Increased prothrombin time An increased prothrombin time would increase the risk for bleeding. Another factor that contributes to increased bleeding risk in clients with liver failure is malabsorption of vitamin K (decrease), which further impairs the synthesis of clotting factors. Increased platelets would not cause increased bleeding but rather increase the risk of clotting, while red blood cell count is not relevant.

A client is admitted to the medical surgical unit with a history of inflammatory bowel disease. The nurse knows that the clinical manifestations of both Crohn disease and ulcerative colitis are the result of activation of which cells?

Inflammatory

Which situations would result in an increased intestinal production of ammonia in a client?

Ingested a high-protein lunch. Was admitted with a gastrointestinal (GI) bleed.

The nurse is caring for a client with heart failure and left atrial enlargement. Which physiologic consequence does the nurse anticipate when atrial natriuretic peptide (ANP) is released due to atrial stretch?

Inhibition of aldosterone

A client presents with sudden onset of hematuria, variable proteinuria, decreased GFR, oliguria, and signs of impaired renal function. Upon taking a history the nurse learns that the client had strep throat 3 weeks ago. Upon renal biopsy the diagnosis of acute glomerulonephritis is confirmed. What mechanism of damage is the most plausible?

Injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane.

In hemodialysis, access to the vascular system is most commonly through:

Internal arteriovenous fistula Access to the vascular system is accomplished through an external arteriovenous shunt (i.e., tubing implanted into an artery and a vein) or, more commonly, through an internal arteriovenous fistula (i.e., anastomosis of a vein to an artery, usually in the forearm).

The community health nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine?

International hepatitis A vaccine is suggested for travelers to regions where sanitation is poor and endemic HAV infections are high, children living in communities with high rates of HAV infection, homosexually active men, and users of illicit drugs.

A client is concerned about acquiring hepatitis A and asks the nurse who should receive the HAV vaccine. Which responses by the nurse are accurate?

International travelers visiting to regions where sanitation is poor Sexually active gay men Users of illicit drugs Workers employed in food handling

A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?

Intrarenal The intrarenal AKI is caused by acute tubular necrosis/acute renal injury. It is characterized by destruction of tubular epithelial cells with acute suppression of renal function. Prerenal AKI is characterized by a marked decrease in renal blood flow. Postrenal results from obstruction of urine outflow from the kidneys.

A nurse is caring for a client admitted for chemotherapy due to bladder cancer. Which route would the nurse anticipate that the chemotherapy will be administered when the goal is to minimize systemic side effects?

Intravesical In many cases, chemotherapeutic or immunotherapeutic agents can be administered intravesically (instilled directly into the bladder), thereby avoiding the side effects of systemic therapy. All other routes provided as options would result in systemic side effects.

Which substance necessary for vitamin B12 absorption is produced by the parietal cells in the stomach?

Intrinsic factor

A 67-year-old retired textile worker has developed bladder cancer. His history shows that he smoked for 25 years and is 30.8 lb (14 kg) overweight. What conclusion can the nurse best draw about the etiology and pathophysiology of his bladder cancer?

It is caused by carcinogens that are excreted in the urine and stored in the bladder.

Which statements are true regarding a Wilms tumor?

It is the most common childhood malignant tumor. It presents with an abdominal mass. Treatment includes chemotherapy, radiation and surgery.

To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. Which rationale for this treatment is the most likely?

It removes water from the filtrate and returns it to the vascular compartment.

The dietitian explains to the client that food is digested and absorbed in the:

Jejenum Food is digested and absorbed in the jejunum and ileum. The stomach serves as a food reservoir during the early stages of digestion. The cecum and colon are parts of the large intestine.

Colonic microorganisms play a role in the synthesis of which vitamin?

K Colonic microorganisms play a role in vitamin synthesis and in absorption of calcium, magnesium, and iron. Colonic flora synthesize vitamin K.

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood?

Kupffer cells Kupffer cells are reticuloendothelial cells that are capable of removing and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid. Langerhans cells are stellate dendritic cells found mostly in the stratum spinosum of the epidermis. Epstein cells do not exist. Davidoff cells are large granular epithelial cells found in intestinal glands.

The nurse is assessing a client exposed to viral hepatitis who is thought to be in the prodromal phase. When assessing the client, which symptoms does the nurse recognize are consistent with this phase?

Lack of appetite Lack of energy Myalgia

Which structure in the gastrointestinal (GI) tract has absorptive function focusing mainly on water resorption?

Large intestine

The nurse is providing dietary instruction for a client with chronic kidney disease (CKD) who is on hemodialysis. Which food would the nurse encourage the client to restrict?

Lean meats

A nurse is reviewing laboratory results of a client with impaired liver function and anticipating which abnormal result indicating injury to liver cells?

Liver enzymes

The nurse is teaching a client about surgical treatments available for chronic viral hepatitis. Which of these is appropriate for the nurse to relate?

Liver transplant

Staghorn kidney stones, or struvite stones, are usually located in the renal pelvis. These stones are made from:

Magnesium ammonium phosphate

A nurse is assessing an older adult with reports of constipation, for which the client often takes over-the-counter medications. What assessment should the nurse perform to address the etiology of the client's problem?

Medication regimen for drugs like anticholinergic agents or calcium

The nurse is caring for a client with asterixis. Which assessment should the nurse make to help a diagnosis of hepatic encephalopathy?

Mental status

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. The increased GFR that occurs in persons with early alterations in renal function is associated with microalbuminuria, defined as urinary albumin excretion of 30 to 300 mg in 24 hours. Microalbuminuria is an important predictor of future diabetic nephropathies. In many cases, these early changes in glomerular function can be reversed by careful control of blood glucose levels. (Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy.) Thus, control of blood pressure (to levels of 130/80 mm Hg or less) and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes.

Digestion of starch begins in which structure?

Mouth

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with which factor of normal age-related change?

Muscle mass

A 35-year-old female ultramarathon runner is admitted to hospital following a day-long, 80-km race because her urinary volume is drastically decreased and her urine is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis. Why is her urine red?

Myoglobinuria Myoglobinuria, which can cause acute tubular necrosis via intratubular obstruction, involves the leaching of myoglobin from skeletal muscle into the urine, bypassing the usual filtration by the glomerulus. Excess exercise and muscle trauma can contribute. While both hemoglobinuria and myoglobinuria discolor the urine, hemoglobinuria results from hemolysis following a reaction to a blood transfusion, whereas myoglobinuria involves muscle damage. A rupture does not cause this change.

A client is admitted with an intestinal obstruction with abdominal bloating. Which type of treatment does the nurse know will help decompress the bowel?

Nasogastric tube to suction The cardinal symptoms of intestinal obstruction are pain, absolute constipation, abdominal distention, sign of fluid volume deficit, and vomiting. Treatment depends on the cause and type of obstruction. Correction of fluid and electrolyte imbalances to baseline levels and measurement of output using a Foley catheter are recommended. Most cases of adynamic obstruction respond to decompression of the bowel through nasogastric suction.

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct?

Nephron destruction takes place over many months. Signs and symptoms develop gradually. Functioning nephrons compensate for those that are damaged. There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed.

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)?

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month

A client admitted to the hospital with elevated blood glucose is diagnosed with type 1 diabetes mellitus. What characteristics commonly differentiate type 1 diabetes mellitus from type 2 diabetes mellitus?

Onset before age 20 Autoimmune beta cell damage Abrupt onset of symptoms

A 55-year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. Which is the most likely diagnosis and possible underlying pathophysiologic problem?

Overactive bladder that may result from both neurogenic and myogenic sources.

An older adult who experiences chronic pain takes prescribed opioid analgesics, which has resulted in frequent fecal impaction. Which renal outcome may directly result from this gastrointestinal complication?

Overflow urinary incontinence

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?

Pain in the right upper quadrant referred to the same shoulder

A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse?

Painless hematuria

The nurse knows that a client with chronic kidney disease (CKD) may experience which changes in skin integrity?

Pale skin Brittle fingernails Decreased perspiration

A student is studying the interstitial cells of Cajal found in the smooth muscle tissue of the gastrointestinal tract. The student says that these cells produce slow waves that are increased in amplitude by the:

Parasympathetic nervous system The amplitude and, to a lesser extent, the frequency of the slow waves, can be modulated by the parasympathetic and sympathetic divisions of the autonomic nervous system. The parasympathetic nervous system increases the amplitude of the slow waves, and the sympathetic system decreases them.

Which hormone increases the number and resorptive function of "bone-chewing" cells?

Parathyroid hormone (PTH) Osteoclasts are "bone-chewing" cells that function in the resorption of bone. PTH increases the number and resorptive function of osteoclasts. Calcitonin or thyrocalcitonin and estrogen reduce the number and function of osteoclasts.

A client has been admitted to the hospital with an exacerbation of peptic ulcer disease. The nurse is aware the client is at risk for:

Perforation Hemorrhage Obstruction

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?

Perform intermittent catheterization

A newborn is found to have transient hypothyroidism following a cesarean birth. Which nursing intervention could have induced the transient hypothyroidism as the staff prepared the mother for the surgical procedure?

Performing a skin scrub with povidone-iodine solution on delivery site

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

Pericarditis Pericarditis occurs in many people with stage 5 CKD due to the uremia and prolonged dialysis. The manifestations of uremic pericarditis resemble those of viral pericarditis with all its potential complications, including cardiac tamponade. The presenting signs include mild to severe chest pain with respiratory accentuation and a pericardial friction rub. Fever is variable in the absence of infection and is more common in dialysis than uremic pericarditis.

Which layer of the digestive tract constitutes the outer wall of the intestine and contains a serous fluid between its two layers?

Peritoneum

While assessing a peritoneal dialysis client in the 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

Which assessment does the nurse recognize is consistent with signs and symptoms of acute pancreatitis?

Periumbilical pain

When teaching a group of nursing students about the liver, the nurse relates that Kupffer cells function to remove harmful substances or cells from the portal blood and venous sinusoids through which process?

Phagocytosis

Secondary diabetes occurs because of disorders that produce hyperglycemia by stimulating the hepatic production of glucose or decrease the cellular use of glucose. Which disorders can be causes of secondary diabetes?

Pheochromocytoma and Cushing syndrome Such diabetes can occur with pancreatic disease or the removal of pancreatic tissue and with endocrine diseases, such as acromegaly, Cushing syndrome, or pheochromocytoma. Endocrine disorders that produce hyperglycemia do so by increasing the hepatic production of glucose or decreasing the cellular use of glucose. Dwarfism, hepatomegaly, and pancreatic hyperplasia do not cause secondary diabetes.

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

Plasmapheresis Plasmapheresis is used to filter the blood for removal of proteins and the circulating anti-GBM antibodies. Renal transplantation would return the kidneys to normal function, but this is the extreme of treatment. The other options would not produce the necessary treatment outcomes

A female client with suspected glomerular disease has been referred to a nephrologist by her family physician. Which finding would help the specialist rule out glomerular disease?

Podocytes encircle the outer surface of glomerular capillaries and connect to the epithelial cells.

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

Polycystic kidney disease

A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?

Postrenal Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter, bladder, or urethra. Due to the increased urine not being able to be excreted due to the obstruction, retrograde pressure occurs throughout the tubules and nephrons, which ultimately damages the nephrons. Prostatic hyperplasia is the most common underlying problem.

A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?

Postrenal failure Postrenal failure results from obstruction of urine outflow from the kidneys. The obstruction can occur in the ureter, bladder, or urethra. Due to the increased urine not being able to be excreted due to the obstruction, retrograde pressure occurs throughout the tubules and nephrons, which ultimately damages the nephrons. Prostatic hyperplasia is the most common underlying problem.

An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?

Prerenal Prerenal failure occurs when vascular volume and renal perfusion are decreased, for example by dehydration. Postrenal failure is the result of obstruction of urine outflow. Intrarenal (intrinsic) failure occurs when nephrons are destroyed.

The anemia that occurs with end-stage kidney disease is often caused by the kidneys themselves. What loss of function in the kidney results in anemia of end-stage kidney disease?

Produce erythropoietin

The nurse is teaching a group of nursing students about the physiologic consequences of hypotension and reduced perfusion to the kidney. Which compensatory mechanism occurs immediately after renin release from the kidney?

Production of angiotensin I

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?

Progressive destruction of the organ

Which intervention would be most effective when caring for an older adult with advanced Alzheimer disease who is experiencing incontinence?

Prompted, timed voiding

The nurse is conducting a community health education program on urinary retention and urinary incontinence. The nurse determines that the participants are understanding the education when they state that the most common cause of urinary retention is:

Prostate enlargement

Which statement is true concerning food digestion?

Protein digestion begins in the stomach.

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

Proteinuria and generalized edema

After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD?

Proton pump inhibitors; avoiding large meals; remaining upright after meals

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 renal location?

Proximal convoluted tubule

When teaching a pharmacology class the nurse relates that 65% of all reabsorptive and secretory processes that occur in the tubular system take place in which area?

Proximal tubules Approximately 65% of all reabsorptive and secretory processes that occur in the tubular system take place in the proximal tubules. There is almost complete reabsorption of nutritionally important substances, such as glucose, amino acids, lactate, and water soluble vitamins.

Phosphate excretion is impaired in chronic kidney disease (CKD), resulting in high serum phosphate levels and the development of phosphate crystals. Which manifestation of hyperphosphatemia should the nurse assess for?

Pruritus

Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?

Pruritus

A client is diagnosed with gouty arthritis. To prevent the buildup of uric acid and recurrence of gout attacks, the nurse teaches the client to avoid eating foods containing which compound?

Purine Uric acid is a product of purine metabolism. Excessively high blood levels (i.e., hyperuricemia) can cause gout, and excessive urine levels can cause kidney stones. Uric acid is freely filtered in the glomerulus and is reabsorbed and secreted into the proximal tubules. Uric acid is one of the anions that use the anion transport system in the proximal tubule. Tubular reabsorption normally exceeds secretion, and the net effect is removal of uric acid from the filtrate. Although the rate of reabsorption exceeds secretion, the secretory process is homeostatically controlled to maintain a constant plasma level. Many people with elevated uric acid levels secrete less uric acid compared to people with normal uric acid levels.

A neonate with feeding difficulties has been diagnosed with esophageal atresia (EA) and tracheoesophageal fistula (TEF). Correction cannot be performed for 1 week. Which interventions will the nurse include when teaching the parents?

Purpose of ligation of the TEF Signs and symptoms of aspiration pneumonia Gastrostomy tube feeding Esophageal suctioning procedures

An anatomy student explains that the funnel-shaped portion of the stomach that connects with the intestine is called which region?

Pyloric region

Regurgitation of bile salts and duodenal contents can lead to gastric ulcers. Which structure prevents this from happening?

Pyloric sphincter

The circular layer of smooth muscle that lies between the stomach and the small intestine is called:

Pyloric sphincter

The nurse assessing a client with a diagnosis of cholelithiasis will look for pain in which area?

RUQ

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which manifestation related to the necrosis of liver cells?

Rapid onset of jaundice Alcoholic hepatitis is the intermediate stage between fatty changes and cirrhosis and is characterized by inflammation and necrosis of liver cells. The condition is always serious and sometimes fatal. The cardinal sign of alcoholic hepatitis is rapid onset of jaundice. Hand tremors are not specific to alcoholic hepatitis. Long muscle group atrophy can occur but is not the primary sign. Development of nodules is not caused by alcoholic hepatitis.

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

Recently had a urinary tract infection

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

A client has experienced an increase in aldosterone secretion as a result of stimulation of the adrenal glands. The nurse anticipates which laboratory value response?

Reduction in urinary sodium levels

An athlete has become dehydrated during a long race in hot weather. Which physiologic process will occur in an attempt to protect the athlete's extracellular fluid volume?

Release of antidiuretic hormone from the posterior pituitary

A client receives a diagnosis of lower urinary tract obstruction. What intervention should the nurse choose to be the immediate treatment for this problem?

Relief of bladder distention

What is the most common cancer of the kidney?

Renal cell carcinoma

The kidney assists in blood pressure regulation by releasing which substance from the juxtaglomerular cells in response to decreased renal blood flow, causing efferent arteriole vasoconstriction?

Renin The kidney releases renin, which enters the bloodstream to convert angiotensinogen to angiotensin I. Angiotensin I travels to the lungs, where it is converted to angiotensin II. Angiotensin II acts directly on the kidneys. Renin functions by means of angiotensin II to produce intrarenal vasoconstriction.

A nurse is assessing a client diagnosed with CKD for neuromuscular manifestation. Select the manifestations the nurse may expect to find.

Restless leg syndrome Loss of recent memory Peripheral neuropathy Perceptual errors

Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two-thirds suffer from what peripheral neuropathy?

Restless legs syndrome

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?

Restrict intake of dietary protein

The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects which physiologic principle?

Salt and water tubular reabsorption Generalized edema, a hallmark of nephrosis, results from salt and water retention and a decrease in plasma colloid osmotic pressure due to loss of albumin in the urine. Glomerulonephritis is characterized by sodium and water retention that causes edema, particularly of the face and hands. Clinical findings of nephrotic syndrome result from increased (rather than decreased) glomerular permeability to the plasma proteins. In renal damage, the inability to concentrate urine causes polyuria and water loss. Outflow obstruction and reflux are associated with microorganisms in the stagnant urine that can ascend along the ureters to infect the kidneys.

A client states that she really is not hungry anymore and seems to have indigestion all the time. The nurse assesses vital signs as normal but the client has significant weight loss over the past 2 months and a family history of gastric cancer. The nurse notifies the health care provider and anticipates an order for which diagnostic test?

Schedule a barium x-ray and endoscopic studies Perform a Papanicolaou smear on the client's gastric secretions Order cytologic studies to be done during the endoscopy

Which protective measure of the peritoneum helps keep abdominal inflammation and infection localized?

Secretes fibrinous substance

Which blood test reflects the glomerular filtration rate (GFR) and is used to estimate renal function?

Serum creatinine

A client who has been diagnosed with Addison disease will likely experience which abnormal lab result related to the absence of aldosterone?

Serum potassium levels elevated

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury?

Sharp decrease in urine output

A nurse reading a sigmoidoscopy report notes that a client was found to have skip lesions. The nurse interprets this as an indication of:

Skip lesions, demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue, are a characteristic feature of Crohn disease.

What intervention does the nurse suggest to a client experiencing pain associated with pancreatic cancer?

Sleeping in a forward sitting position

Villi are anatomic features that contribute to the enlarged surface area of the:

Small intestine

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

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte?

Sodium One type of RTA results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of sodium ions with decreased elimination of hydrogen and potassium ions. Glucose is not an electrolyte.

The nurse is analyzing the results of a client's urinalysis. Which finding requires the need for follow-up by the nurse because it is an abnormal result?

Specific gravity 1.034 Normal findings are: Color: yellow amber; appearance: clear to slightly hazy; specific gravity: 1.005-1.025 with a normal fluid intake; pH: 4.5-8.0 - average person has a pH of about 5 to 6; volume: 600-2500 mL/24 hour - average volume is 1200 mL/24 hour; glucose: negative; ketones: negative; blood: negative; protein: negative; bilirubin: negative; urobilinogen: 0.5-4.0 mg/day; nitrate for bacteria: negative; leukocyte esterase: negative; casts negative: occasional hyaline casts; red blood cells: negative or rare; crystals: negative (none); white blood cells: negative or rare; epithelial cells: few; hyaline casts 0-1/lpf (low-power field).

The nurse teaches the client that which of these contributed to the development of acute cholelithiasis?

Stasis of bile Two primary factors contribute to the formation of gallstones: abnormalities in the composition of bile and the stasis of bile (rather than rapid elimination). Inflammation of the gallbladder alters the absorptive characteristics of the mucosal layer, allowing excessive absorption of water and bile salts. Although a number of factors are associated with the development of acute pancreatitis, most cases result from gallstones (rather than cause gallstone formation) or alcohol use disorder. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct; alcohol intake is not a factor in the development of cholesterol or bilirubin stones.

The results of a client's 24-hour stool specimen indicate 20 g or more of fat. The nurse would interpret this as:

Steatorrhea

Gastrin production, a task that is performed by the stomach, results in which effect?

Stimulation of gastric acid secretion by parietal cells

The production of chyme occurs in which organ?

Stomach

The cause of gastric carcinomas has been influenced by which factors?

Strain of Helicobacter pylori (H. pylori) Environmental factors Family history

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 56-year-old client reports urinary incontinence when laughing. The nurse documents this as which type of incontinence?

Stress

A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?

Stress incontinence

A nurse administering a client's medication tells the client that a proton pump inhibitor has been added. When the client asks the purpose of the medication, the nurse responds that it is to prevent:

Stress ulcer

The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration?

Stress ulcers refer to GI ulcerations that develop in people with large-surface-area burns.

Which carbohydrate is matched to its correct enzyme needed for digestion?

Sucrose is a dietary carbohydrate digested by sucrase, an enzyme. This produces the monosaccharides fructose and glucose.

The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer?

Surgical removal Radiation therapy Chemotherapy

There are two types of joints in the human body. They are synarthroses and synovial joints. Synarthroses joints are further broken down into three types of joints. What type of joint occurs when bones are connected by hyaline cartilage?

Synchondroses Synchondroses are joints in which bones are connected by hyaline cartilage and have limited motion.

The nurse will monitor which clients at risk for the development of chronic kidney disease (CKD)?

Systemic lupus erythematosus Polycystic kidney disease Glomerulonephritis Diabetes

A client is admitted with an exacerbation of Crohn disease and has been experiencing a weight loss of 20 pounds in 2 weeks. The client is unable to absorb nutrients from the intestine. The nurse would expect which type of diet to be ordered for this client?

TPN

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

A client is diagnosed with choledocholithiasis and acute suppurative cholangitis and is being rushed to surgery to prevent which possible complication?

The accumulation of purulent bile, which can cause sepsis. Complications of choledocholithiasis include acute suppurative cholangitis when purulent bile fills and distends bile ducts. It is characterized by the presence of an altered sensorium, lethargy, and septic shock. Bilirubinuria and malabsorption are not emergency situations. This situation is not part of the etiology of hepatitis.

An older adult client with an upper respiratory infection for several weeks has presented with urinary retention. The client reports taking nonprescription cold medications over and above the suggested dose. Which medication most likely is contributing to this urinary retention?

The anticholinergic effects of the medication are impairing normal bladder function.

A nurse is caring for a client who has just experienced a spinal cord injury. Which bladder dysfunctions will the client likely experience during the early stage of injury?

The bladder becomes atonic.

An older adult states that he awakens at least three times each night to void. When assessing the client, what potential causative factor should the nurse prioritize?

The client takes his prescribed beta-blocker and diuretic each evening at bedtime. Taking diuretics in the evening can cause nocturia. The fact that the client mostly drinks tea and coffee is unlikely to cause nocturia. Frequency is not suggestive of bladder cancer. Glucosamine supplements are not linked to changes in voiding behavior.

The common bile duct opens into which part of the gastrointestinal tract?

The duodenum contains the opening for the common bile duct and the main pancreatic duct.

A busy 45-year-old female executive has been diagnosed with diverticulitis. Her primary treatment is an increase in the fiber content of her diet. What effect will the fiber have on the diverticula?

The fiber increases bulk, promotes regular defecation, and increases colonic contents and colon diameter, thereby decreasing intraluminal pressure.

A client suffering from chronic hypertension is beginning to show the symptoms of glomerular disease. This client's kidney damage is due to what phenomenon?

The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation.

Which function of the kidneys helps to maintain the pH balance in the body?

The kidneys conserve base bicarbonate and eliminate hydrogen ions.

The nurse is caring for a client who has produced an average of 20 mL/hour for the previous day. The nurse recognizes this compares in which way to the normal urine output?

The kidneys should produce about 1.5 L of urine each day.

A 56-year-old woman has been diagnosed with CKD. She first went to the doctor due to complications of hypertension. How are hypertension and CKD related?

The mechanisms that produce hypertension in CKD include an increased vascular volume and increased activity of the renin-angiotensin-aldosterone system.

Place the following steps relating to swallowing in order in which they occur.

The tongue moves the food to the back of the mouth. The food is lifted to the posterior wall of the pharynx. The soft palate is pulled upward and the nasopharynx is blocked. The pharynx uses involuntary, constrictive movements to move the food. The walls of the esophagus are stretched. Local and central nervous system reflexes initiate peristalsis.

When caring for a client with primary biliary cirrhosis, which of these statements by the nurse will best teach the client about the cause of this problem?

There is autoimmune destruction of the bile ducts.

Which statement is true concerning gastric enterocytes?

They secrete enzymes that aid in digestion of proteins.

Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume?

Thiazide diuretics Because of its effect on uric acid secretion, aspirin is not recommended for treatment of gouty arthritis. Thiazide and loop diuretics also can cause hyperuricemia and gouty arthritis, presumably through a decrease in ECF volume and enhanced uric acid reabsorption.

A client has been diagnosed with an incompetent pyloric sphincter. This client is experiencing a lot of abdominal pain and nausea. When this client vomits, the nurse should expect what type of secretions will be in the basin?

Thick, brownish, foul-smelling emesis

Which would be considered the function of secretory glands in the gastrointestinal tract?

To produce mucus to lubricate the wall of the gastrointestinal tract To secrete fluid and enzymes to aid in digestion

Which substance is broken down by the emulsification process?

Triglycerides

Which enzymes are responsible for the breakdown of protein?

Trypsin and elastase

Primary biliary cirrhosis is an autoimmune disease that destroys the small intrahepatic bile ducts causing cholestasis. It is insidious in onset and is a progressive disease. What are the earliest symptoms of the disease?

Unexplained pruritus

Primary biliary cirrhosis is an autoimmune disease that destroys the small intrahepatic bile ducts causing cholestasis. It is insidious in onset and is a progressive disease. What are the earliest symptoms of the disease?

Unexplained pruritus The earliest symptoms are unexplained pruritus or itching, weight loss, and fatigue, followed by dark urine and pale stools. The other answers are not indicative of primary biliary cirrhosis.

Which signs and symptoms are most suggestive of acute cholecystitis?

Upper right quadrant or epigastric pain

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

The parietal cells of the stomach produce hydrochloric acid to protect the mucosal covering from gastric erosion. The nurse understands that Helicobacter pylori (H. pylori) produces an enzyme that enables its survival in this acidic environment. Which enzyme does H. pylori produce?

Urease As the most common cause of chronic gastritis, H. pylori is able to buffer the acidity of their immediate environment by producing sufficient ammonia, which is created from secreting an enzyme called urease. These properties help to explain why the organism is able to survive in the acidic environment of the stomach.

The nurse is caring for a client who is diagnosed with gout. Which laboratory study does the nurse monitor to monitor this condition?

Uric acid levels

A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention?

Urinary catheterization

The formation of magnesium ammonium phosphate (struvite) kidney stones is directly associated with which cause?

Urinary tract infections

A client has a routine urine sample during an annual checkup. Which result is an expected finding in a healthy individual?

Urine specific gravity of 1.020

Which nerve controls the esophageal phase of swallowing?

Vagus The vagus nerve controls the esophageal phase of swallowing because of the vagus innervation in the lower esophageal sphincter. The other nerves control the oral and pharyngeal phases of swallowing.

The client chews an apple and starts the process of swallowing. As food enters the client's esophagus, the nurse recognizes that which nerve innervates the sphincter in the lower esophagus?

Vagus nerve

Which complication may result when a client has malabsorption syndrome?

Vitamin K deficiency Malabsorption syndrome can result in a loss of fat in the stools, therefore causing failure to absorb the fat-soluble vitamins and resulting in vitamin K deficiency. It does not curtail mucus production or immune metabolism, and it does not precipitate excessive release of pepsin.

Rotavirus is most severe in children under 24 months of age. What is a typical symptom of rotavirus infection?

Vomiting that disappears around the second day but diarrhea continues

The nurse administers the drug vasopressin to a client with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which way?

Water will be retained and decreased urine output will result.

Select the option that best describes the sensory process involved in the inhibition of micturition.

When the bladder is distended to 150 to 250 mL in the adult, the sensation of fullness is transmitted to the spinal cord and then to the cerebral cortex, allowing for conscious inhibition of the micturition reflex.

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 Wilms tumor gene, WT1, which is located on chromosome 11, encodes a transcription factor that is critical for normal kidney development. Roughly 20% of all Wilms tumors carry WT1 mutations. Renal cell carcinoma is a different mutation, as is Alport syndrome. Pyelonephritis is an infection.

A young adult male presents to the emergency department with a new onset of lower abdominal pain that has worsened significantly over the past 12 hours. Admission blood work shows stable electrolyte levels but leukocytosis. What nursing action is most appropriate?

Withhold food and drinks in anticipation of surgery

When assessing the client during the icteric phase of viral hepatitis, which of these findings does the nurse anticipate observing?

Yellow-tinged sclera The icterus phase is reflected by development of jaundice of skin and sclera, liver tenderness, and worsened prodromal symptoms.

A newborn is admitted to the hospital with a high bilirubin level of 13 mg/dL (222.35 µmol/L). The assessment data related to this lab value includes:

Yellowish discoloration of the skin Yellowing of the sclera of the eye Dark-colored urine

A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called:

Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumor (gastrinoma).

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 loss of over half the client's normal kidney function.

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:

activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.

A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed:

acute postinfectious glomerulonephritis. The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR decreases, is one of the first symptoms.

A client arrives in the emergency department semi-comatose. Her breath has a "fruity" smell. Their initial blood glucose level is >600. Her mouth and mucous membranes are dry. The health care providers suspect the client may be experiencing hyperglycemic hyperosmolar syndrome. In this situation, the nurse can expect the client's lab results to reflect:

an increase in glomerular filtration rate [GFR].

The physician has prescribed a thiazide diuretic for a client. The nurse anticipates that the medication will:

block the tubular reabsorption of sodium. The thiazide diuretics, which are widely used to treat disorders such as hypertension, block sodium reabsorption in renal tubules and enhance the active reabsorption of calcium into the blood via the calcium-sodium exchange transport mechanism. If a client experienced a decrease in circulatory volume, this would activate the renin-angiotensin system, decrease the GFR, or release ADH.

A client with a history of renal insufficiency is experiencing a flare-up of his arthritis and he has increased his daily dose of ibuprofen (an NSAID). Knowing the effect that ibuprofen has on prostaglandin synthesis, the nurse should anticipate:

decrease renal blood flow resulting in decrease in urine output.

A 9-year-old boy has just been diagnosed with the nephritic syndrome. The first stage of his disease will result in:

glomerular damage.

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection. Which finding should the nurse expect?

increased nitrites

A client with osteoarthritis states that every morning "it gets harder and harder to loosen up". The client's main therapy to this point is the use of over-the-counter nonsteroidal anti-inflammatories (NSAIDs). These drugs reduce the client's pain by:

inhibiting prostaglandin synthesis. The primary cause of discomfort in OA is rooted in inflammation. NSAIDs inhibit cyclooxygenase (COX)-mediated synthesis of prostaglandins, which have a damaging effect on joint structures. They do not interact with opioid receptors or promote cytokine release. NSAIDs tend to reduce blood flow at inflammation sites as part of their anti-inflammatory effect.

In the emergency department, a client arrives following a car accident. His pulse is 122; BP 88/60; respiration is 18 bpm. Urine output is 4 mL over the first hour on arrival. When in shock, this lower urine output is primarily due to:

innervation of the sympathetic nervous system, causing constriction of the afferent arteriole.

A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver:

metabolizes most components of food and also cleans the blood of bacteria and drugs.

A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:

nephrotoxic acute tubular necrosis (ATN). The development of nephrotoxic acute tubular necrosis is due to the concentration effect of the kidney. The prolonged exposure to the chemotherapy agent causes the ATN. The disease state would progress faster than the CRF, and the glomerulus would not be affected. Anemia is not related to this type of chemotherapy.

A client is not able to absorb vitamin B12. The nurse determines that the client is deficient in:

parietal (oxyntic) cells, which secrete HCl and intrinsic factor.

A client is admitted with worsening heart failure. The client is reporting frequent urination recently. The nurse knows that the physiology behind the body's response to decreased vascular volume by increasing urine output is due to:

release of atrial natriuretic peptide (ANP) from overstretched atria. ANP is believed to play an important role in salt and water excretion by the kidney. It is synthesized by muscle cells in the atria of the heart and released when the atria are stretched. Increased levels of this peptide directly inhibit the reabsorption of sodium and water in the renal tubules. ANP also inhibits renin secretion and therefore angiotensin II formation, which in turn reduces reabsorption of sodium. The decrease in sodium reabsorption increases urine output and helps return blood volume to normal. ANP levels, which become elevated when the atria are stretched in HF, help to decrease vascular volume by increasing urine output. Potassium reabsorption is not responsible for water excretion. Aldosterone secretion by the adrenal gland functions in the regulation of sodium and potassium elimination by the principal cells in the distal and collecting tubules.

A 68-year-old man who has smoked for at least 50 years reports that lately he feels as though food is "getting stuck" in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting stuck. On questioning, he reports drinking at least five alcoholic beverages nearly every day. His problem is most likely:

squamous cell carcinoma of the esophagus. Alcohol and tobacco use are the main risk factors for squamous cell carcinoma of the esophagus and dysphagia is a common presenting complaint. Hiatal hernias and GERD do not cause dysphagia. Scleroderma is unrelated to the client's presentation or history.

A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is:

the damaged kidney is unable to produce erythropoietin.

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.

An older adult client who recently started taking furosemide tells the nurse about now experiencing problems with urine incontinence. Which type of incontinence is this client likely experiencing?

transient Transient incontinence is caused by medications such as long-acting sedatives and hypnotics, psychotropic medications, and diuretics such as furosemide. It can also be caused by rectal distension, fecal impaction, and acute cystitis or polyuria. Overflow incontinence is an involuntary loss of urine that occurs when intravesical pressure exceeds the maximal urethral pressure. Stress incontinence is the involuntary loss of urine during coughing, laughing, sneezing, or lifting that increases intra-abdominal pressure because of pelvic floor muscle dysfunction.