week 6

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

hydronephrosis.

Treatment of a uterine prolapse may involve the insertion of a(n) _ to hold the uterus in place. catheter. IUD. pessary. endopelvic mesh implant.

pessary

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

polyuria and sodium wasting

The best intervention for acute kidney injury is .

prevention

Renal insufficiency occurs________ when of the nephrons are not functional. a. 25% 50% 75% to 90% more than 90%

75% to 90%

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 respondsa. "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. 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 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. 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.

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

a 70-year-old patient with heart failure.

E.coli is the cause for majority of

urinary tract infections

Sexually active women are more prone to

urinary tract infections

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

a. calcium.

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

b. Escherichia coli.

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

b. calcium.

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

b. nephralgia

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

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

bilateral kidney stones

Smoking is a risk factor for

bladder cancer

· Hematuria is the most frequent and initial symptom of

bladder cancer

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

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

Vulvovaginitis is commonly caused by

candida albicans

Hypertension is both a cause of chronic kidney disease and a result of

chronic kidney disease.

Acute tubular necrosis can occur from (Select all that apply.) increased ammonia levels from liver failure. contrast dyes used for radiologic studies. ischemia because of hypovolemia. antibiotics that are nephrotoxic.

contrast dyes used for radiologic studies. ischemia because of hypovolemia. antibiotics that are nephrotoxic.

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

contrast media.

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 acute glomerulonephritis. crescentic glomerulonephritis. post-streptococcal glomerulonephritis. chronic glomerulonephritis.

crescentic glomerulonephritis.

· Vesicoureteral reflux can lead to recurrent

cystitis

The most common types of uterine tumors are known as a. ovarian cysts. endometriomas. hydatidiform moles. leiomyomas.

leiomyomas.

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

acute glomerulonephritis.

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

pelvic muscle weakness.

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

pelvic tumor.

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

acute tubular necrosis.

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

ACE inhibitors

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

a. hypercalciuria.

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% Greater than 25% nephron loss Greater than 50% nephron loss Greater than 90% nephron loss

Greater than 90% nephron loss

A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating 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. 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. 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. We had better measure his blood sugar. He may have developed diabetes, and

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.

A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type_____ hypersensitivity reaction.

III

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

GFR declines.

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

a. pain

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

Polycystic kidney disease

Which symptom would be manifested in a woman diagnosed with pregnancy-induced hypertension? (Select all that apply.) Excessive vomiting Proteinuria Peripheral edema Increased arterial pressure Hemorrhage

Proteinuria Peripheral edema Increased arterial pressure

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

Uremia

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

a.fever

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

albumin is excreted in the urine.

Scrotal pain in males and labial pain in females may accompany renal pain as a result of associated infections. associated dermatomes. muscle tension. anxiety.

associated dermatomes.

Glomerular disorders include pyelonephritis. obstructive uropathy. interstitial cystitis. nephrotic syndrome.

nephrotic syndrome.

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. caused by a streptococcal infection. c. associated with supernumerary kidney. d. genetically transmitted.

d. genetically transmitted.

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

d. man who has chronic urinary tract infections.

A progressive decrease in the force of the urinary stream, dribbling of urine, and difficulty initiating the urinary stream are characteristic of prostatitis. urinary calculi. c. bladder carcinoma. d. prostatic enlargement

d. prostatic enlargement

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.

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

decreased secretion of erythropoietin.

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

dehydration.

A 32-year-old female complaining of severe pain with menstruation and inability to participate in her routine household activities is likely experiencinga. dysmenorrhea .b. menorrhagia. c. amenorrhea. d. metrorrhagia.

dysmenorrhea.

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

elderly patient with hypertrophy of the prostate.

A 48-year-old female who is having hot flashes, tachycardia, palpitations, and sleep disturbance may be experiencing symptoms related to a. pregnancy. b. perimenopause. c. ovulation. d. endometriosis.

endometriosis.

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

erythropoietin administration.

Appropriate therapy for prerenal kidney injury includes fluid administration. potassium supplementation. fluid restriction. protein restriction.

fluid administration.

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

fluid excess and electrolyte imbalance.

It is true that polycystic kidney disease is always rapidly fatal. caused by a streptococcal infection. associated with supernumerary kidney. genetically transmitted.

genetically transmitted.

Risk factors for renal carcinoma include (Select all that apply.) genetics. hypotension. cigarette smoking. obesity. chemicals.

genetics. cigarette smoking. obesity. chemicals.

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.

hematuria

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

hematuria.

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

hematuria.

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

hematuria.

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

hepatocytes synthesize excessive lipids.

The diet for a patient with chronic kidney disease (CKD) should include high carbohydrates and fats low sodium and potassium. high protein. low phosphorous. high calorie.

high carbohydrates and fats low sodium and potassium. low phosphorous. high calorie.

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

high-serum potassium levels. high-serum phosphorous. high-blood urea nitrogen. anemia.

Excessive vomiting in pregnant women is known as placenta previa. hyperemesis gravidarum. abruptio placentae. d. spontaneous abortion

hyperemesis gravidarum

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

hyperkalemia.

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

hyperparathyroidism.

One of the most frequent causes of chronic kidney disease is hypertension. glomerulonephritis. chronic pyelonephritis. polycystic kidney disease.

hypertension.

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

oliguria

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

immune system damage to the glomeruli.

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

increased serum creatinine.

A change occurring in a pregnant woman that is indicative of a potential disorder is increased metabolic rate. 30% to 40% increase in cardiac output. increased oxygen consumption. increased urinary protein.

increased urinary protein.

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

infection by E. coli.

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 initiation of dialysis. fluid restriction. antibiotics. phlebotomy.

initiation of dialysis.

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

insufficient erythropoietin.

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

insufficient metabolic acid excretion resulting from nephron loss.

The expected treatment of a pregnant woman with hyperemesis gravidarum is immediate cesarean section. seizure prophylaxis. surgical removal of uterine contents. intravenous therapy

intravenous therapy

The difference between stress incontinence and urge incontinence is that stress incontinence occurs in women, whereas urge incontinence occurs in both men and women. occurs during sleep, whereas urge incontinence occurs during the waking hours. is caused by a pelvic floor muscle problem, whereas urge incontinence is caused by a problem with the detrusor muscle. is caused by a detrusor muscle problem, whereas urge incontinence is caused by a neurologic problem.

is caused by a pelvic floor muscle problem, whereas urge incontinence is caused by a problem with the detrusor muscle.

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

ischemic conditions.

Characteristics of cystitis include more common in women. less complicated in men. associated with catheterization of the bladder. fostered by stasis of urine. usually resolve without treatment.

more common in women associated with catheterization of the bladder. fostered by stasis of urine.

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

regeneration of the renal tubular epithelium.

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

renal colic.

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

sepsis.

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

serum creatinine.

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

severe hypotension

The urea-splitting bacteria contribute to the formation of kidney stones. struvite calcium oxalate uric acid cystine

struvite

Cystitis symptoms include (Select all that apply.) CVA tenderness. suprapubic pain. dysuria. fever.

suprapubic pain. dysuria. fever.

Cryptorchidism poses a risk for

testicular cancer

Sudden, severe testicular pain is indicative of prostatitis. testicular cancer. testicular torsion. epididymitis.

testicular torsion.

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

the glomerular membrane has increased permeability.

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

they are deficient in active vitamin D

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

throat infection.

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

tubular

Ureterocele is a cystic dilation of the

ureter

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.

uric acid crystals.

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

uric acid crystals.

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

urinary retention and reflux.

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

urine concentration. urine PH. metabolic/congenital conditions. dietary intake.