wack!

Serious renal impairment generally does not occur until ____ of the total nephrons have been damaged a.20% b.40% c.60% d.80%

d.80%

Which intervention has been found to retard the advancement of chronic kidney disease? a.Calcium supplementation b.Erythropoietin c.Insulin d.ACE inhibitors

d.ACE inhibitors

A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate, because a.the basement membrane becomes increasingly permeable. b.filtration exceeds secretory and reabsorptive capacity. c.excessive solute and water are lost in the urine. d.GFR declines.

d.GFR declines.

In patients with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease? a.Greater than 15% b.Greater than 25% nephron loss c.Greater than 50% nephron loss d.Greater than 90% nephron loss

d.Greater than 90% nephron loss

Approximately two-thirds of the water and electrolytes filtered by the kidney are reabsorbed by the a.loop of Henle. b.collecting tubule. c.distal tubule. d.proximal tubule.

d.proximal tubule.

The effect on the renal tubules during the postoliguric phase of acute tubular necrosis involves a.reconstruction of the basement membrane. b.blocking the tubule lumens by dead cells. c.making the glomeruli patent again. d.regeneration of the renal tubular epithelium.

d.regeneration of the renal tubular epithelium.

The most common cause of ischemic acute tubular necrosis (ATN) in the United States is a.hypotension. b.hypovolemia. c.renal artery stenosis. d.sepsis.

d.sepsis.

The best intervention for acute kidney injury (AKI) is ________.

prevention

Detrusor muscle overactivity can be improved by administration of a.alpha-receptor agonists. b.botulinum toxin. c.cholinergic agents. d.nonsteroidal antiinflammatory agents.

b.botulinum toxin.

The most common type of renal stone is a.uric acid. b.calcium. c.struvite. d.cysteine.

b.calcium.

The manifestations of acute pyelonephritis (Select all that apply.) a.are mild and insidious. b.can result in dehydration. c.often include symptoms of lower urinary tract infection. d.include fever, chills, and costovertebral angle tenderness. e.may include urosepsis.

b.can result in dehydration. c.often include symptoms of lower urinary tract infection. d.include fever, chills, and costovertebral angle tenderness. e.may include urosepsis.

The primary risk factors for renal cell carcinoma include (Select all that apply.) a.genetics. b.cigarette smoking. c.obesity. d.hypertension. e.nulliparous women.

b.cigarette smoking. c.obesity. d.hypertension.

Acute tubular necrosis can occur from (Select all that apply.) a.increased ammonia levels from liver failure. b.contrast dyes used for radiologic studies. c.ischemia due to hypovolemia. d.antibiotics that are nephrotoxic.

b.contrast dyes used for radiologic studies. c.ischemia due to hypovolemia. d.antibiotics that are nephrotoxic.

The type of glomerulonephritis which is most likely to result in a swift decline in renal function that then progresses to acute kidney injury is a.acute glomerulonephritis. b.crescentic glomerulonephritis. c.post-streptococcal glomerulonephritis. d.chronic glomerulonephritis.

b.crescentic glomerulonephritis.

A major modifiable risk factor for nephrolithiasis is a.positive family history. b.dehydration. c.smoking. d.drinking alcohol.

b.dehydration.

The underlying mechanism which directly results in glycosuria is a.filtration of glucose from the glomerulus. b.exceeding the threshold for glucose reabsorption. c.secretion of glucose into the distal tubule. d.the mechanism is unknown.

b.exceeding the threshold for glucose reabsorption.

The consequence of an upper urinary tract obstruction in a single ureter is a.kidney stone formation. b.hydronephrosis. c.dilation of the urethra. d.anuria.

b.hydronephrosis

The main driving force for glomerular filtration is a.oncotic pressure in the Bowman's capsule. b.hydrostatic pressure in glomerular capillaries. c.permeability of the glomerular membrane. d.solute content of the blood in the glomerular capillaries.

b.hydrostatic pressure in glomerular capillaries.

The major cause of glomerulonephritis is a.infection of the glomerular capsule secondary to a urinary tract infection. b.immune system damage to the glomeruli. c.hydronephrosis resulting from kidney stones. d.Streptococcus infection that migrates from the bloodstream to the glomerulus.

b.immune system damage to the glomeruli.

The pain that accompanies kidney disorders is called a.nephritic. b.nephralgia. c.nephrotic. d.nephronitis.

b.nephralgia.

It is true that glucose reabsorption in the tubules a.occurs passively. b.occurs in the proximal convoluted tubule. c.is unlimited. d.simply does not occur.

b.occurs in the proximal convoluted tubule.

The defining characteristic of severe acute kidney injury is a.proteinuria. b.oliguria. c.hematuria. d.diuresis.

b.oliguria.

The direct cause of stress incontinence is a.the effect of aging. b.pelvic muscle weakness. c.neurologic conditions. d.detrusor muscle overactivity.

b.pelvic muscle weakness.

One cause of an extrinsic renal system obstruction is a.clot. b.pelvic tumor. c.neurogenic bladder. d.papillary necrosis.

b.pelvic tumor.

Signs consistent with a diagnosis of glomerulonephritis include a.anuria. b.proteinuria. c.red blood cell casts in the urine. d.foul-smelling urine.

b.proteinuria.

The main clinical manifestation of a kidney stone obstructing the ureter is a.oliguria. b.renal colic. c.urge incontinence. d.an abdominal mass.

b.renal colic.

When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of protein," the nurse's response is based on the knowledge that a.his glomeruli have been damaged by his own immune system. b.the glomerular membrane has increased permeability. c.his liver is extremely active in synthesizing protein. d.his renal tubules are full of cellular debris.

b.the glomerular membrane has increased permeability.

The infection frequently associated with development of postinfectious acute glomerulonephritis is a.pneumonia. b.throat infection. c.endocarditis. d.urinary tract infection.

b.throat infection.

The most common cause of intrinsic kidney injury is _____ injury. a.glomerular b.tubular c.interstitial d.vascular

b.tubular

A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating a."Since he was oliguric for so long, he probably has rebound polyuria. As long as his blood pressure is stable, he is not hypovolemic, so I would not worry." b."I am glad you noticed this change. It happened so gradually that we did not see it. We should call the doctor and get him to measure ADH." c."His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered." d."We had better measure his blood sugar. He may have developed diabetes, and what you see is osmotic diuresis from glucose in the urine."

c."His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered."

Renal insufficiency occurs when _____ of the nephrons are not functional. a.25% b.50% c.75% to 90% d.more than 90%

c.75% to 90%

What problem is a patient likely to experience in end-stage renal disease? a.Hypokalemia b.Polyuria and nocturia c.Uremia d.Hematuria

c.Uremia

Postrenal acute kidney injury may be caused by a.severe hypotension. b.glomerulonephritis. c.bilateral kidney stones. d.acute tubular necrosis.

c.bilateral kidney stones.

Anemia in people who have end-stage chronic renal disease is caused by a.chronic loss of blood in the urine. b.poor appetite, with lack of iron intake. c.decreased secretion of erythropoietin. d.increased secretion of aldosterone.

c.decreased secretion of erythropoietin.

Appropriate management of end-stage renal disease includes a.potassium supplementation. b.a high-protein diet. c.erythropoietin administration. d.a high-phosphate diet.

c.erythropoietin administration.

Findings that should prompt an evaluation for renal cancer include a.bacteria in the urine. b.intermittent urinary colic. c.hematuria. d.red blood cell casts in the urine.

c.hematuria.

Nephrotic syndrome does not usually cause a.hyperlipidemia. b.proteinuria. c.hematuria. d.generalized edema.

c.hematuria.

The most likely cause of acidosis in a patient with end-stage renal disease is a.insufficient filtration of bicarbonate ions at the glomerulus. b.excessive production of respiratory and metabolic acids. c.insufficient metabolic acid excretion due to nephron loss. d.hypoventilation secondary to uremic central nervous system depression.

c.insufficient metabolic acid excretion due to nephron loss.

Renin is released from a.the posterior pituitary gland. b.the liver. c.juxtaglomerular cells. d.macula densa cells.

c.juxtaglomerular cells.

Serum creatinine may be increased by a.carbohydrate intake. b.fat intake. c.muscle breakdown. d.fluid intake.

c.muscle breakdown.

The primary function of the vasa recta is to a.secrete renin. b.reabsorb NaCl. c.reabsorb interstitial fluid. d.secrete urea.

c.reabsorb interstitial fluid.

Excess potassium is excreted from the body by the renal system primarily via a.glomerular filtration based on blood level of potassium. b.reabsorption based on blood level of potassium. c.secretion based on aldosterone level. d.an unknown mechanism.

c.secretion based on aldosterone level.

Which condition is caused by a genetic defect? a.Acute pyelonephritis b.Hydroureter c.Incontinence d.Polycystic kidney disease

d.Polycystic kidney disease

Which finding on urinalysis should prompt further evaluation? a.pH 4.5 b.Red blood cells 2 per high-power field c.Specific gravity of 1.015 d.White blood cells 20 per high-power field

d.White blood cells 20 per high-power field

The pathophysiologic basis of acute glomerulonephritis is a.renal ischemia. b.bacterial invasion of the glomerulus. c.an anaphylactic reaction. d.an immune complex reaction.

d.an immune complex reaction.

It is true that polycystic kidney disease is a.always rapidly fatal. b.due to a streptococcal infection. c.associated with supernumerary kidney. d.genetically transmitted.

d.genetically transmitted.

The condition associated with end-stage chronic renal disease that is the most immediately life threatening is a.azotemia. b.increased creatinine. c.hypertension. d.hyperkalemia.

d.hyperkalemia.

A primary laboratory finding in end-stage chronic renal disease is a.decreased blood urea nitrogen (BUN). b.decreased serum sodium. c.metabolic alkalosis. d.increased serum creatinine.

d.increased serum creatinine.

The most common direct cause of acute pyelonephritis is a.urine obstruction. b.systemic bacteremia. c.urethral catheterization. d.infection by E. coli.

d.infection by E. coli.

The individual at highest risk of pyelonephritis who requires monitoring for signs of its occurrence is the a.woman who is paraplegic. b.woman who is pregnant. c.man who has glomerulonephritis. d.man who has chronic urinary tract infections.

d.man who has chronic urinary tract infections.

The glucose transporter in the proximal tubule a.has no transport maximum. b.does not depend on sodium reabsorption. c.is ATP dependent. d.may be saturated at high filtered glucose loads.

d.may be saturated at high filtered glucose loads.

Glomerular disorders include a.pyelonephritis. b.obstructive uropathy. c.interstitial cystitis. d.nephrotic syndrome.

d.nephrotic syndrome.

Urinary retention with consistent or intermittent dribbling of urine is called a.mixed incontinence. b.enuresis. c.stress incontinence. d.overflow incontinence.

d.overflow incontinence.

If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues, the patient will then experience a.oliguria and sodium retention. b.infections and sepsis. c.magnesium and phosphorus loss in urine. d.polyuria and sodium wasting.

d.polyuria and sodium wasting.

Nephrotic syndrome involves loss of large amounts of ________ in the urine. a.blood b.sodium c.glucose d.protein

d.protein

The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is a.hematuria. b.bacteriuria. c.glycosuria. d.proteinuria.

d.proteinuria.

The glomerular filtration rate is most accurately reflected in the a.blood urea nitrogen level. b.urinary output. c.serum osmolality. d.serum creatinine level.

d.serum creatinine level.

A person is unaware that his bladder is full of urine, but complains that he is leaking urine almost constantly. The most accurate term for this type of incontinence is a.overflow. b.stress. c.urge. d.mixed.

a.overflow

________ is both a cause of chronic kidney disease and a result of chronic kidney disease.

Hypertension

The risk for contrast media-induced acute tubular necrosis (ATN) is highest in a.a 70-year-old patient with heart failure. b.a 50-year-old patient post gallbladder surgery. c.a 12-year-old patient with recurrent bladder infections. d.a 30-year-old patient with appendicitis.

a.a 70-year-old patient with heart failure.

The condition characterized by oliguria and hematuria is a.acute glomerulonephritis. b.polycystic kidney disease. c.cystitis. d.renal insufficiency.

a.acute glomerulonephritis.

Activation of parasympathetic nerves to the bladder will cause a.bladder contraction. b.bladder relaxation. c.sphincter contraction. d.urine reflux.

a.bladder contraction.

A common component of renal calculi is a.calcium. b.cholesterol. c.creatinine. d.urobilirubin.

a.calcium.

The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN) in hospitalized patients is a.contrast media. b.antibiotics. c.cancer chemotherapy. d.recreational drugs.

a.contrast media.

The patient most at risk for post-renal acute kidney injury is a(n) a.elderly patient with hypertrophy of the prostate. b.middle-aged woman with bladder infection. c.young child with reflux at the ureterovesical junction. d.patient who has both hypertension and diabetes.

a.elderly patient with hypertrophy of the prostate.

A person with acute pyelonephritis would most typically experience a.fever. b.oliguria. c.edema. d.hypertension.

a.fever

Appropriate therapy for prerenal kidney injury includes a.fluid administration. b.potassium supplementation. c.fluid restriction. d.protein restriction.

a.fluid administration.

The oliguric phase of acute tubular necrosis is characterized by a.fluid excess and electrolyte imbalance. b.fever and diminishing cognition. c.sodium retention and potassium loss in the urine. d.magnesium and phosphorous loss in the urine.

a.fluid excess and electrolyte imbalance.

Factors that increase the glomerular filtration rate include a.fluid volume excess. b.increased hydrostatic pressure in the Bowman's capsule. c.high oncotic pressure in glomerular capillary blood. d.obstruction in the renal tubules.

a.fluid volume excess.

Risk factors for renal carcinoma include (Select all that apply.) a.genetics. b.hypotension. c.cigarette smoking. d.obesity. e.chemicals.

a.genetics. c.cigarette smoking. d.obesity. e.chemicals.

The primary selectivity barrier for glomerular filtration is the a.glomerular basement membrane. b.endothelial tight junctions. c.epithelial fenestra. d.mesangial cells.

a.glomerular basement membrane.

In addition to renal colic pain, signs or symptoms of ureteral stones may frequently include a.hematuria. b.postrenal renal failure. c.urinary urgency. d.proteinuria.

a.hematuria.

Hyperlipidemia occurs in nephrotic syndrome because a.hepatocytes synthesize excessive lipids. b.lipids are not excreted in the urine. c.body fats are catabolized. d.muscles stop burning triglycerides for energy.

a.hepatocytes synthesize excessive lipids.

The diet for a patient with chronic kidney disease (CKD) should include (Select all that apply.) a.high carbohydrates and fats. b.low sodium and potassium. c.high protein. d.low phosphorous. e.high calorie.

a.high carbohydrates and fats. d.low phosphorous. e.high calorie.

Signs of late chronic renal failure include (Select all that apply.) a.high-serum potassium levels. b.high-serum calcium. c.high-serum phosphorous. d.high-blood urea nitrogen. e.anemia.

a.high-serum potassium levels. c.high-serum phosphorous. d.high-blood urea nitrogen. e.anemia.

Calcium oxylate stone formation is facilitated by a.hypercalciuria. b.hypoparathyroidism. c.low urine pH. d.protein intake.

a.hypercalciuria.

Osteoporosis commonly occurs in patients with end-stage renal disease because of a.hyperparathyroidism. b.hypercalcemia. c.excess active vitamin D. d.phosphorous deficiency.

a.hyperparathyroidism.

One of the most frequent causes of chronic kidney disease is a.hypertension. b.glomerulonephritis. c.chronic pyelonephritis. d.polycystic kidney disease.

a.hypertension.

At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema, congestive signs in the pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include a.initiation of dialysis. b.fluid restriction. c.antibiotics. d.phlebotomy.

a.initiation of dialysis.

The most likely cause of anemia in a patient with end-stage renal disease is a.insufficient erythropoietin. b.blood loss secondary to hematuria. c.vitamin B12 deficiency secondary to deficient intrinsic factor. d.iron deficiency.

a.insufficient erythropoietin.

One of the most common causes of acute tubular necrosis (ATN) is a.ischemic conditions. b.cytotoxic agents. c.immune reaction. d.prolonged postrenal kidney injury.

a.ischemic conditions.

The normal post-void residual urine in the bladder is a.less than 100 milliliters. b.150 to 200 milliliters. c.250 to 300 milliliters. d.none of these; no normal residual volume is identified.

a.less than 100 milliliters.

When a patient misses two dialysis sessions numerous electrolyte imbalances resulted. The patient will likely demonstrate (Select all that apply.) a.lethargy due to metabolic acidosis and increased BUN. b.skeletal muscle weakness and possible cardiac dysrhythmias due to hyperkalemia. c.positive Chvostek and Trousseau signs due to hypomagnesemia. d.weight gain of several pounds since her last dialysis session due to hypernatremia. e.deep rapid breathing due to compensatory mechanism for metabolic acidosis.

a.lethargy due to metabolic acidosis and increased BUN. b.skeletal muscle weakness and possible cardiac dysrhythmias due to hyperkalemia. e.deep rapid breathing due to compensatory mechanism for metabolic acidosis.

The most common sign/symptom of renal calculi is a.pain. b.vomiting. c.hematuria. d.oliguria.

a.pain.

An important sign of glomerular basement membrane dysfunction is a.proteinuria. b.hematuria. c.glycosuria. d.urinary casts.

a.proteinuria.

The most helpful laboratory value in monitoring the progression of declining renal function is a.serum creatinine. b.serum potassium. c.blood urea nitrogen. d.mental status changes.

a.serum creatinine.

Prerenal acute kidney injury may be caused by a.severe hypotension. b.glomerulonephritis. c.bilateral kidney stones. d.acute tubular necrosis.

a.severe hypotension.

The urea-splitting bacteria (Proteus, Klebsiella, and Pseudomonas) contribute to the formation of ________ kidney stones. a.struvite b.calcium oxalate c.uric acid d.cystine

a.struvite

The physiology that explains the intermittent nature of pain caused by a kidney stone is that a.ureters use peristalsis and gravity to move urine. b.ureters insert into the bladder at an angle. c.in men, the prostate gland surrounds the urethra. d.in men, the urethra is longer than in women.

a.ureters use peristalsis and gravity to move urine.

In addition to E. coli, a risk factor for development of pyelonephritis is a.urinary retention and reflux. b.nephrotic syndrome. c.respiratory disease. d.glomerulonephritis.

a.urinary retention and reflux.

Renal stone formation is affected by (Select all that apply.) a.urine concentration. b.urine PH. c.metabolic/congenital conditions. d.dietary intake. e.potassium level.

a.urine concentration. b.urine PH. c.metabolic/congenital conditions. d.dietary intake.

A patient injured severely in a motor vehicle accident is hospitalized with acute kidney injury as well as multiple broken bones and lacerations. When family members ask what is meant by the term 'prerenal,' the nurse responds a."The doctors are not sure what caused your husband's acute kidney injury, but they are working to help him recover." b."Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney." c."Your husband's kidney injury is only the beginning of the problems that are expected, so they are being vigilant." d."Acute kidney injury is a new term for what people used to call acute renal failure."

b."Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney."

A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-streptococcal glomerulonephritis. When asked, "Why is my urine the color of coffee?", the nurse responds a."Normally, red blood cells that enter the urine are taken back into the blood, but in glomerulonephritis, the kidney disease you have, they stay in the urine and make it coffee-colored." b."Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored." c."The bacteria that caused your sore throat have traveled to your kidneys and are causing a little damage there that allows some red blood cells to leak into your urine and make it orange-colored." d."When parts of your kidneys stopped working, your blood kept flowing and broke some of your little blood vessels, so red blood cells are flowing into your urine and making it coffee-colored."

b."Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored."

The organism most commonly associated with acute pyelonephritis is a.Streptococcus. b.Escherichia coli. c.Klebsiella. d.Enterobacter.

b.Escherichia coli.

Which group is at the highest risk for urinary tract infection? a.Infants and children b.Sexually active women c.Adult males d.Patients taking diuretics

b.Sexually active women

Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing a.hydronephrosis. b.acute tubular necrosis. c.nephrosis. d.renal inflammation.

b.acute tubular necrosis.

A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. This happens because a.hepatocyte failure decreases albumin synthesis. b.albumin is excreted in the urine. c.albumin leaks into the interstitial spaces. d.malnutrition is part of nephrotic syndrome.

b.albumin is excreted in the urine.

Scrotal pain in males and labial pain in females may accompany renal pain due to a.associated infections. b.associated dermatomes. c.muscle tension. d.anxiety.

b.associated dermatomes.

Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because a.excess potassium leaches calcium from bone. b.erythropoietin secretion is impaired. c.urea causes demineralization of bone. d.they are deficient in active vitamin D.

d.they are deficient in active vitamin D.

A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be a.potassium oxalate. b.struvite. c.cysteine. d.uric acid crystals.

d.uric acid crystals.