Patho PrepU Chp 25

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

A streptococcal infection 7 to 12 days prior to onset

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

Anomalies of the genitourinary system

A patient 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 last 2 weeks?"

A 34 year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis, stating, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the man'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."

The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit pyuria and high counts of urine colony-forming units?

A client who has urinary catheter in place due to confusion

A patient is being evaluated for kidney stones. The nurse anticipates the patient will manifest:

Acute onset of colicky or dull and achy intermittent flank pain

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 diagnosis is the most likely?

Acute pyelonephritis

A patient is concerned that medication may damage his kidneys. Which factor(s) place the patient at most risk for developing a drug-related nephropathy? Select all that apply.

Age/elderly Prescription methicillin and other synthetic antibiotics Diuretics Procedures involving radiocontrast media Nonsteroidal anti-inflammatory drugs (NSAIDs)

A nurse is caring for a patient with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which of the following manifestations?

Albumin

A four year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the healthcare team's initial differential diagnosis most likely be?

Alport syndrome

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

Autosomal recessive polycystic kidney disease (ARPD)

Acute pyelonephritis is a result of which of the following?

Bacterial infection

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

A nurse is caring for a patient with systemic lupus erythematosis (SLE). The patient asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which of the following factors was present in the urine?

Blood or protein

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

Calcium

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

Catheter-associated bacteriuria

Which of the following best describes nephronophthisis-medullary cystic kidney disease?

Cysts are restricted to the corticomedullary border.

Which one of the following is the usual cause of acute pyelonephritis?

Infection

Which laboratory findings should you expect to see in a patient diagnosed with nephritic syndrome?

Elevated urine protein and hypoalbuminemia

Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?

Excruciating pain in the flank and upper outer quadrant of abdomen that radiates to bladder area.

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

Extracorporeal shock wave lithotripsy (ESWL)

A nurse on an acute medical unit of a hospital has admitted a 62 year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?

Flank pain, dysuria and nausea and vomiting are likely assessment findings.

A patient has passed a kidney stone composed of uric acid (urate). Which of the following pathological conditions is a contributing factor for the development of this type of kidney stone?

Gout

When assessing a patient with acute pylenephritis, the nurse would expect the patient to exhibit which of the following symptoms?

High fever Flank tenderness Nausea and vomiting Chills

A nurse is caring for a patient who has a recent history of passing calcium urinary stones. Which of the following is a priority nursing consideration for this patient?

Hydration

A nine year-old boy has been diagnosed with the nephritic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options.

Hypoalbuminemia Increased glomerular membrane permeability. Decreased colloidal osmotic pressure Proteins escape from plasma to glomerular filtrate. Accumulation of fluid in interstitial tissue (edema).

The nurse is assessing a patient who has a unilateral obstruction of the urinary tract. The nurse anticipates the patient may develop:

Increase in blood pressure

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally

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 nurse is planning care for a patient with a urinary tract obstruction. The nurse includes assessment for which of the following possible complications?

Increased blood pressure

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

Increased blood pressure

A patient is to receive a radiocontrast media as part of a diagnostic scan. Which of the following is intended to reduce the nephrotoxic effects of the radiocontrast media?

Increasing the normal saline intravenous infusion rate to 125 mL/hour

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 glomerular nephritis is confirmed. What mechanism of damage is the most plausible?

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

Which of the following can be said about acute drug-induced interstitial nephritis? Select all that apply.

It is an autoimmune disease. It may be related to a sensitivity to sulfonamide drugs. It manifests as a fever, hematuria, mild proteinuria, and possibly a rash. It may result in acute renal failure.

The nurse should assess which of the following when assessing for the initial presence of edema in a patient with nephrotic syndrome?

Lower extremities

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

Magnesium ammonium phosphate

A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a patient. Which would be the most important information for the nurse to provide?

Microalbuminemia is a predictor of future nephropathies.

A nurse is caring for a patient who is diagnosed with acute poststreptococcal glomerulonephritis. Which of the following is the most common clinical presentation of this condition?

Nephritic syndrome

Both type 1 and type 2 diabetes mellitus can cause damage to the glomeruli of the kidneys. What renal disease is diabetic nephropathy associated with?

Nephrotic syndrome

Which are contributing factors of acute postinfectious glomerulonephritis? Select all that apply.

Occurs after infection of group A ?-hemolytic streptococci. May result from impetigo. Primarily infects the pharynx.

The nurse is evaluating her patient's risk for an urinary tract infection. Which of the following patients has the highest risk?

Patient with obstructed urinary outflow from the kidney

A patient diagnosed with Goodpasture's syndrome would require which of the therapies to remove proteins and autoantibodies from the system?

Plasmapheresis

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 one of the following would the nurse see as being liable to cause the most serious long-term problems?

Polycystic kidney disease

Which of the following substances would not be found in glomerular filtrate?

Protein

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

Protein in the urine

The nurse reviews the lab results for a patient who has advanced autosomal dominant polycystic kidney disease (ADPKD). The patient 's hemoglobin is 8.8 g/dL. The nurse suspects this lab value is related to which of the following causes?

Reduced production of erythropoietin

A 22 year-old female with a history of intermittent flank pain, repeated UTIs and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis?

She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.

A nurse is caring for a patient who has been diagnosed with kidney colic and has not yet passed the stone. Which of the following interventions should the nurse be sure to include when planning the care for this patient?

Strain the urine.

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.

A nurse observes that a patient's urine is cola colored and considers which of the following as a possible reason?

The patient's urine contains material from the degradation of red blood cells.

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.

A patient is being treated with colchicine (Colcrys) for pain in the big right toe. The patient begins to complain of severe right flank pain and is diagnosed with kidney stones. Which of the following types of kidney stones does the nurse recognize this patient is most likely affected by?

Uric acid

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 tumour

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 family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. The nurse responds:

corticosteroids.