Patho Prep U Renal

A 10-year-old girl has developed a lower urinary tract infection (UTI). Which symptoms does the nurse correlate with this diagnosis in the older child? Select all that apply.

Suprapubic discomfort Enuresis Dysuria In older children with lower UTIs, the classic features—enuresis, frequency, dysuria, and suprapubic discomfort—are more common. Abdominal pain is seen in toddlers. Vomiting is also seen in toddlers

Which client is displaying manifestations of having a kidney stone?

Acute onset of colicky flank pain radiating to lower abdomen One of the major manifestations of kidney stones is pain. Depending on the location, there are two types of pain associated with kidney stones-colic or noncolic. 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 client with a history of chronic pyelonephritis has been admitted several times with recurrent bacterial infection of the urinary tract. The nurse should anticipate educating this client with regard to which common treatment regimen?

Continue taking antibiotics for 10 to 14 days even if symptoms of infection disappear. Chronic pyelonephritis involves a recurrent or persistent bacterial infection superimposed on urinary tract obstruction, urine reflux, or both. Chronic obstructive pyelonephritis can be bilateral (caused by conditions that obstruct bladder outflow) or unilateral (such as occurs with ureteral obstruction). Cranberry juice, forced micturition, and diuretics are not standard treatments for chronic pyelonephritis.

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

Corticosteroids

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 factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II 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.

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

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

Following an episode of strep throat, the school nurse notices the child has not recovered from this illness a week later. Upon further investigation, the nurse notices that the child has developed water retention. Which assessments support this conclusion? Select all that apply.

Periorbital edema Swelling of the hands and fingers 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. Fluid retention usually results in an elevated BP, not a normal one. Vomiting and dizziness are not associated with this diagnosis.

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

Proteinuria and generalized edema The nephrotic syndrome is characterized by massive proteinuria and lipiduria, along with an associated hypoalbuminemia, generalized edema, and hyperlipidemia. Hematuria and anemia may be associated with a cancer. Renal colic is characteristic of kidney stones. Increased creatinine may be associated with systemic lupus erythematosus.

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 Hypertension and cigarette smoking have been implicated in the progression of diabetic nephropathy. The control of blood pressure (the client has a normal BP at this time) and smoking cessation will help prevent the progression of diabetic nephropathy. The other dietary interventions may be recommended; however, there is not a correlation that they will prevent the development of diabetic nephropathy.

The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change?

Urine cloudy with strong odor Older adults are prone to infections without obvious symptoms of fever and purulent drainage. Approximately 50% of all older adults with infections will develop vague symptoms such as anorexia, fatigue, weakness, or change in mental status. Constipation is not noted for stimulating mental status changes. Loss of hearing from malfunctioning hearing aids is most likely to cause difficulties of communication.

The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include:

protein in the urine. In a person with nephrotic syndrome there is massive proteinuria (protein in the urine), serum hypoalbuminemia, generalized edema, and hyperlipidemia.

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

Corticosteroids 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.

What is the most common cause of a lower urinary tract infection?

Escherichia coli Most uncomplicated lower UTIs are caused by Escherichia coli. The other organisms can cause UTIs, but are not the most common cause of infection.

Which pathophysiologic changes are associated with nephrotic syndrome? Select all that apply.

Hypoproteinemia Glomerular damage Nephrotic syndrome is not a specific glomerular disease but a constellation of clinical findings that result from an increase in glomerular permeability and loss of plasma proteins in the urine. Any increase in glomerular membrane permeability allows proteins to escape from the plasma into the glomerular filtrate. Massive proteinuria results, leading to hypoalbuminemia. Generalized edema results from the loss of colloidal osmotic pressure of the blood with subsequent accumulation of fluid in the interstitial tissues. Glomerular damage results in proteinuria, hypoproteinemia, decreased plasma oncotic pressure, and compensatory synthesis of proteins by the liver (leading to hyperlipidemia).

The nurse is assessing a client who has a unilateral obstruction of the urinary tract. Which clinical finding by the nurse correlates to this diagnosis?

Increase in blood pressure Hypertension is an occasional complication of urinary tract obstruction. It is more common in cases of unilateral obstruction in which renin secretion is enhanced, probably secondary to impaired renal blood flow. In these circumstances, removal of the obstruction often leads to a reduction in blood pressure. The urine output would be decreased and not diluted.

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 There are two routes by which bacteria can gain access to the kidney: ascending infection from the lower urinary tract and through the bloodstream. Ascending infection from the lower urinary tract is the most important and common route by which bacteria reach the kidney, resulting in acute pyelonephritis. Diabetes, peripheral vascular disease, and hypertension controlled by a diuretic and an ACE inhibitor and are not associated with acute pyelonephritis.

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 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.

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client:

will not undergo an acute kidney injury by decreasing renal blood flow. Some drugs (diuretics, high-molecular-weight radiocontrast media, the immunosuppressive drugs cyclosporine and tacrolimus, and nonsteroidal anti-inflammatory drugs) can cause acute kidney injury by decreasing renal blood flow. Checking creatinine levels does not predict the client's allergies, a kidney stone, or tolerance for stress testing.

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 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