Prep U: Ch 25: Disorders of Renal Function

A client had been diagnosed with a simple cyst of the kidney and is presenting with symptoms. Which manifestations does the nurse anticipate the client will display? Select all that apply.

Hematuria Hypertension Infection explanation: Most simple cysts do not produce signs or symptoms, or compromise renal function. When symptomatic, they may cause flank pain, hematuria, infection, and hypertension related to ischemia-produced stimulation of the renin-angiotensin system. They are most common in persons older than age 50 years.

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

Increased blood pressure explanation: Urinary tract obstruction can lead to hypertension related to increased renin secretion. The urine output would be decreased and not diluted.

What is the usual cause of acute pyelonephritis?

Infection explanation: Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the most common causative agents for acute pyelonephritis.

A young adult client has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?

"Have you had any type of infection within the past 2 weeks?" explanation: Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens. Other organism can also cause this infection.

A client has been taking up to 2400 mg of ibuprofen per day for chronic pain following a motor vehicle accident. The client is diagnosed with chronic analgesic nephritis. The client states, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the client's statement?

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." explanation: High flow and pressure combined with the metabolic transformation of drugs makes the kidneys vulnerable to drug toxicity. They do not play a backup role to the liver in the metabolism of drugs, and while structural and functional damage may occur with drug overuse, infection is a less likely consequence. Older adults are particularly vulnerable to drug-related nephritis and nephropathies, but it would be incorrect to conclude that younger people are completely immune.

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

A client who has a urinary catheter in place due to confusion explanation: Catheters are among the greatest risks for urinary tract infections (UTIs), which are associated with bacteriuria, most frequently caused by Gram-negative infections in hospitalized clients. None of the other factors is closely associated with the development of UTIs.

A client has been diagnosed with systemic lupus erythematosus. The client now presents with sudden hematuria, variable proteinuria, and a decreased glomerular filtration rate. What is a probable diagnosis?

Acute nephritic syndrome explanation: Acute nephritic syndrome may occur as a secondary complicating disorder in systemic diseases, such as SLE. In its most dramatic form, acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished glomerular filtration rate (GFR), oliguria, and signs of impaired renal function.

Which client is displaying manifestations of having a kidney stone?

Acute onset of colicky flank pain radiating to lower abdomen explanation: One of the major manifestations of kidney stones is pain. Depending on the location, there are two types of pain associated with kidney stones—colicky or noncolicky. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in men. Stones are not externally visible or palpable. Obstruction by a stone may result in urinary retention and increased fluid volume.

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 explanation: 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.

Most primary glomerular disease is caused by which pathophysiologic disorder?

Autoimmunity explanation: Most cases of primary and many cases of secondary glomerular disease probably are immune in origin.

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

Autosomal recessive explanation: 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.

The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which disorder?

Autosomal recessive polycystic kidney disease (ARPKD) explanation: The typical infant with ARPKD presents with bilateral flank masses accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension.

The most important information for a nurse to give a client who has been diagnosed and treated for a calcium oxalate stone would include which facts related to their diet?

Avoid spinach and peanuts explanation: Persons who form calcium oxalate stones may need to decrease their intake of foods that are high in oxalate (e.g., spinach, Swiss chard, cocoa, chocolate, pecans, and peanuts). Taking a thiazide diuretic helps to prevent calcium stone redevelopment but is not a dietary change.

Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)?

Bilateral flank masses and impaired lung development explanation: Clinical manifestations of the typical infant with ARPKD include bilateral flank masses, accompanied by severe renal failure, signs of impaired lung development, and variable degrees of liver fibrosis and portal hypertension. Potter facies and other defects associated with oligohydramnios may be present. Hypertension is usually noted within the first few weeks of life and is often severe.

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

Calcium explanation: Most kidney stones are calcium stones—calcium oxalate, calcium phosphate, or a combination of the two materials. Clients who have had intestinal bypass surgery are at a higher risk for developing calcium kidney stones.

Which client would the nurse consider having the highest risk for developing a urinary tract infection?

Client with obstructed urinary outflow from a kidney stone explanation: Factors that contribute to the development of ascending infections of the urinary tract are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, sexually active women, postmenopausal women, and neurogenic bladder.

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

Corticosteroids explanation: The disorder usually is treated with corticosteroids. Although kidney transplantation is the preferred treatment for end-stage kidney disease, focal segmental glomerulonephritis occurs in half of these people. Pain medications may help relieve symptoms but will not treat the disease. Antivirals and antibiotics are not effective in FSGS.

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

Extracorporeal shock wave lithotripsy (ESWL) explanation: ESWL is a nonsurgical treatment that uses sound waves, laser, or dry shock wave energy to break apart the stones. All of the other procedures are surgical in nature.

A middle-aged woman is admitted with acute pyelonephritis. Which assessment finding correlates with this diagnosis?

Flank pain, dysuria, and nausea/vomiting explanation: Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea, and vomiting. Chronic rather than acute pyelonephritis is often caused by hypertension, while most cases are caused by ascending bacteria, not systemic infections. Scarring is more commonly a result of chronic pyelonephritis.

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II explanation: Polycystic kidney disease is typically related to dominant or recessive hereditary mutations in polycystin. The other options are related to urinary tract infections. Some drugs, such as diuretics, high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and the NSAIDs can cause acute prerenal failure by decreasing renal blood flow.

Which medication does the nurse administer that will lower urinary calcium by increasing tubular reabsorption to prevent kidney stone formation?

Hydrochlorothiazide explanation: Thiazide diuretics, such as hydrochlorothiazide, lower urinary calcium by increasing tubular reabsorption so that less remains in the urine. Drugs that bind calcium in the gut may be used to inhibit calcium absorption and urinary excretion.

Surgical stone removal is indicated for which instance?

Obstruction of urine flow explanation: Open stone surgery may be required to remove large calculi or those that are resistant to other forms of removal. Kidney stones are a major cause of upper urinary tract obstruction.

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

Palpable flank mass Hematuria Often silent in the early stages explanation: Kidney cancer is largely a silent disorder during its early stages, and symptoms usually denote advanced disease. Presenting features 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. It is, however, intermittent and may be microscopic; as a result, the tumor may reach considerable size before it is detected. One of the features of renal cell carcinoma is its ability to metastasize.

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

Plasmapheresis explanation: 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

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

Polycystic kidney disease explanation: Polycystic kidneys may be associated with aneurysm, and subarachnoid hemorrhage is a frequent cause of death. Agenesis refers to failure of an organ to develop at all. The other kidney usually undergoes compensatory hypertrophy and performs the function of the missing kidney. Most simple cysts do not produce signs or symptoms or compromise renal function. A horseshoe kidney occurs when the upper and lower poles of the two kidneys are fused, producing a horseshoe-shaped structure. The condition usually does not cause problems.

A nurse is caring for a child with Wilms tumor, stage I. Which statements are true regarding this diagnosis? Select all that apply.

Prognosis is good with treatment. The tumor is limited to the kidney and can be excised with the capsular surface intact. explanation: Long-term survival rates have increased to 90% for Wilms tumor stages I through III. The tumors usually are staged using the National Wilms' Tumor Study Group classification: stage I tumors are limited to the kidney and can be excised with the capsular surface intact.

A child has been admitted to the pediatric unit with a tentative diagnosis of lipoid nephrosis. While taking the history, which items lead the nurse to suspect the diagnosis is accurate? Select all that apply.

Recent routine vaccines Recent upper respiratory infection explanation: Lipoid nephrosis (also known as minimal-change disease) is most commonly seen in children (peak incidence at 2 to 6 years of age), but may occasionally occur in adults. Although the cause of minimal-change disease is unknown, children in whom the disease develops often have a history of recent upper respiratory infections or of receiving routine childhood immunizations. It has not been associated with common childhood illnesses like swimmer's ear, vomiting/diarrhea, or getting a new tooth.

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 explanation: As ADPKD progresses, the nephrons reduce the production of erythropoietin (EPO). EPO is necessary for red blood cell production by bone marrow, so EPO deficiency causes anemia.

What is the most common cancer of the kidney?

Renal cell carcinoma explanation: Renal cell carcinoma accounts for 80% to 90% of all kidney tumors.

A nurse observes that a client's urine is cola colored and considers which factor as a possible reason?

The client's urine contains material from the degradation of red blood cells. explanation: When red blood cells degrade in the urine, urine may appear cola colored.

A young woman presents with signs and symptoms of urinary tract infection (UTI). The nurse notes that this is the fifth UTI in as many months. What would this information lead the nurse to believe?

There is possible obstruction in the urinary tract. explanation: Urinary tract obstruction encourages the growth of microorganisms and should be suspected in persons with recurrent UTIs. The other answers can cause lower UTIs, but an obstruction would be considered because of the frequency of the infections.

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

a streptococcal infection 7 to 12 days prior to onset. explanation: Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A beta-hemolytic streptococci and is caused by deposition of immune complexes. It also may occur after infections by other organisms, including staphylococci and a number of viral agents, such as those responsible for mumps, measles, and chickenpox.

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. explanation: 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.

Acute pyelonephritis is a result of:

Bacterial infection explanation: Acute pyelonephritis represents a bacterial infection of the upper urinary tract, specifically the kidney parenchyma and renal pelvis. Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the common causative agents. Staphylococcus species and Streptococcus faecalis may also cause pyelonephritis, but they are uncommon.

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 explanation: The normal flow of urine functions to wash bacteria from the urinary tract. If a client is not drinking enough, urine can become stagnant and promote infection. Increased consumption of water will increase the washout. Water has no effect on acidity, consistency of mucus, or immune function.