Chapter 33: all Disorders of Renal Function no explanation

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.

Which substance would not be found in glomerular filtrate?

Protein

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.

A frantic parent reports a large mass in the child's abdomen; after diagnostic testing, the health care provider diagnoses a Wilms tumor, stage IV. After the provider leaves the room, the parents ask the nurse, "What does this mean?" Which response by the nurse is most accurate?

"A cancer of the kidney has most likely spread to the lungs."

A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds:

"All glomeruli and all parts of the glomeruli are involved." Glomerular changes can be diffuse, involving all glomeruli and all parts of the glomeruli; focal, meaning only some of the glomeruli are affected; segmental, involving only a certain segment of each glomerulus; and mesangial, affecting only mesangial cells.

What is the most common cancer of the kidney?

Renal cell carcinoma

A school nurse is teaching a group of fourth-grade girls about personal hygiene. Important teaching points aimed at reducing the incidence of urinary tract infection (UTI) include which of the following? Select all that apply. -Daily tub baths -Avoiding bubble baths -Wiping from front to back after a bowel movement -Careful hand washing

-Avoiding bubble baths -Wiping from front to back after a bowel movement -Careful hand washing

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).

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

Acute pyelonephritis is a result of: A. Bacterial infection B. Renal failure C. Viral infection D. Chronic reflux

A. Bacterial infection 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.

Select the manifestations of renal cell carcinoma. Select all that apply. -Often silent in the early stages -Hematuria -Palpable flank mass -Does not metastasize

-Often silent in the early stages -Hematuria -Palpable flank mass

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 poor even with treatment. -Prognosis is good with treatment. -The tumor is limited to the kidney and can be excised with the capsular surface intact. -The tumor has undergone hematogenous metastasis, most commonly involving the lung.

-Prognosis is good with treatment. -The tumor is limited to the kidney and can be excised with the capsular surface intact.

What are appropriate interventions in the care of a client diagnosed with renal calculi? Select all that apply. -Straining the client's urine -Addressing the client's pain -Restricting the client's oral fluid intake -Keeping track of intake and output -Inserting a Foley catheter

-Straining the client's urine -Addressing the client's pain -Keeping track of intake and output

A young child has been diagnosed with Wilms tumor after the parent discovered an unusual mass, prompting a diagnostic workup. Which tumor characteristic is typical of Wilms tumor? A. Encapsulated B. Asymptomatic C. Self-limiting D. A secondary neoplasm

A. Encapsulated Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. It is not a self-limiting health problem, and chemotherapy, radiotherapy, and/or surgery may be utilized. Symptoms include hypertension, abdominal pain, and vomiting.

4. A 73-year-old man presents to his family physician with complaints of recent urinary hesitation and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which of the following clinical consequences would his care provider expect prior to the resolution of his health problem? A) Hydroureter and pain B) Development of renal calculi and renal cysts C) Unilateral hydronephrosis and pain D) Development of glomerulonephritis or nephrotic syndrome

A

9. A 4-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 health care team's initial differential diagnosis most likely be? A) Alport syndrome B) Systemic lupus erythematosus glomerulonephritis C) Henoch-Schönlein purpura nephritis D) Immunoglobulin A nephropathy

A

Which individual is at the highest risk of developing a urinary tract infection (UTI)?

A 30-year-old woman with poorly controlled diabetes mellitus

6. A female client with suspected glomerular disease has been referred to a nephrologist. The nurse knows that which of the following clinical manifestations may be present with the diagnosis of acute nephritic syndrome? Select all that apply. A) Sudden onset of hematuria B) Proteinuria C) Flank pain D) Excess urine output E) Edema

A,B,E

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

Autosomal recessive

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication? A. Decreased blood pressure B. Diluted urine C. Increased blood pressure D. Polyuria

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

One of the most damaging effects of urinary obstruction on kidney structures is which effect? A. Renal hypertension B. Kidney hyperplasia C. Urinary stasis D. Concentrated urine

C. Urinary stasis Stasis of urine predisposes to infection and stone formation, and progressive dilation of the renal collecting ducts and renal tubular structures. Most commonly, the person has pain, signs and symptoms of urinary tract infection, (UTI) and manifestations of renal dysfunction, such as an impaired ability to concentrate urine. Progressive atrophy of the kidney is caused by obstruction of the outflow of urine. Hypertension is an occasional complication of urinary tract obstruction, since urine flow is obstructed rather than renal blood flow.

Which condition/disorder would the nurse see as being likely to cause the most serious long-term problems? A. Horseshoe kidney B. Simple renal cyst C. Unilateral renal agenesis D. Polycystic kidney disease

D. Polycystic kidney disease 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.

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally The kidneys are usually enlarged in people with autosomal dominant polycystic kidney disease and may achieve enormous sizes. The external contours of the kidneys are distorted by numerous cysts. The kidneys are also enlarged in autosomal recessive polycystic kidney disease.

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

Increased blood pressure

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

Increased blood pressure

A client has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which measures should the client integrate into his or her lifestyle to reduce the risk of recurrence?

Increased fluid intake and dietary changes

Wilms tumor is a tumor of childhood. It is usually an encapsulated mass occurring in any part of the kidney. What are the common presenting signs of a Wilms tumor?

Large asymptomatic abdominal mass and hypertension Wilms tumor is often discovered inadvertently, and it is not uncommon for the mother to discover it while bathing the child. Some children may present with abdominal pain, vomiting, or both.

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?

Lower extremities Initially, the edema presents in the dependent parts of the body, such as the lower extremities, but becomes more generalized.

A nurse is caring for a client diagnosed with nephrotic syndrome. The nurse is aware that the client may manifest which of the following? Select all that apply.

Massive proteinuria (>3.5 g/day) Lipiduria Generalized edema Hyperlipidemia

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

Microalbuminemia is a predictor of future nephropathies. The increased glomerular filtration rate (GFR) that occurs in persons with early alterations in renal function is associated with microalbuminuria, which is an important predictor of future diabetic nephropathies.

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

Nephrotic syndrome The lesions of diabetic nephropathy most commonly involve the glomeruli and are associated with three glomerular syndromes: nonnephrotic proteinuria, nephrotic syndrome, and chronic renal failure. The other answers are not commonly associated with diabetic nephropathy.

Which of the following clients is at greatest risk for developing a urinary tract infection (UTI)?

Older adult female client admitted with an indwelling Foley catheter that has been in place for 1 month

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?

Plasma proteins The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to plasma proteins. Some of nephrotic glomerular injury results from circulating antigen-antibody complexes that become trapped in the glomerular membrane. The nephritic syndromes are characterized by hematuria with red cell casts.

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

Plasmapheresis 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

The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects which physiologic principle?

Salt and water tubular reabsorption

One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte?

Sodium

Drug-related nephropathies involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on?

State of hydration The tolerance to drugs varies with age and depends on renal function, state of hydration, blood pressure, and the pH of the urine.

A nurse is caring for a client who has been diagnosed with kidney colic but has yet passed the stone. Which interventions would the nurse emphasize when planning the care for this client?

Strain the urine.

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.

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 tumor

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

a streptococcal infection 7 to 12 days prior to onset.

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 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.

While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which high-risk factor with the development of this cancer?

Heavy smoking

An adult client has been diagnosed with polycystic kidney disease. Which statement by the client demonstrates an accurate understanding of this diagnosis?

"I suppose I should be tested to see if my children might inherit this."

1. A pediatric unit will be receiving an 8-day-old infant with a suspected congenital renal disorder. Which of the following renal abnormalities could be the possible cause? Select all that apply. A) One of the infant's kidneys may have failed to develop normally. B) The kidneys may be misshapen and have cysts present. C) The upper or lower poles of the two kidneys may be fused. D) Renal cell carcinoma may be present. E) Urine-filled dilation of renal pelvis associated with atrophy of the kidney may be present.

A) One of the infant's kidneys may have failed to develop normally.B) The kidneys may be misshapen and have cysts present.C) The upper or lower poles of the two kidneys may be fused.

7. A 9-year-old boy has been diagnosed with the nephrotic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options. A) Hypoalbuminemia B) Increased glomerular membrane permeability C) Decreased colloidal osmotic pressure D) Proteins escape from the plasma to the glomerular filtrate E) Accumulation of fluid in the interstitial tissue (edema)

A,B,C,D,E

5. A client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable? Select all that apply. A) "You may need to cut out cocoa, chocolate, and some nuts from your diet." B) "It's important that you avoid high-calcium foods like milk, cheese, and yogurt." C) "We will come up with a plan to safely limit your fluid intake over the next few weeks." D) "Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones." E) "Most likely your stones can be dissolved by medications over the next several days."

A,D

A client who developed acute pyelonephritis asks the nurse what may have caused the infection. Which should be included in the nurse's response? Select all that apply. A. Acute pyelonephritis is caused by bacterial infection. B. Severe hypertension often is a contributing factor in the progress of the disease. C. Urinary reflux is the most common cause. D. Escherichia coli is the causative agent in about 80% of cases. E. Outflow obstruction, catheterization, and urinary instrumentation

A. Acute pyelonephritis is caused by bacterial infection. D. Escherichia coli is the causative agent in about 80% of cases. E. Outflow obstruction, catheterization, and urinary instrumentation Acute pyelonephritis is an acute suppurative inflammation of the kidney caused by bacterial infection. Escherichia coli is the causative agent in about 80% of cases. Factors that contribute to the development of complicated acute pyelonephritis are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder. Reflux is the most common cause of chronic pyelonephritis. Severe hypertension is a contributing factor in the progression of chronic pyelonephritis

The nurse is caring for a 9-year-old child who has been diagnosed with urinary tract infection (UTI). Which is a commonly associated manifestation of this disorder? A. Enuresis B. Anuria C. Encopresis D. Endoscopic

A. Enuresis In older children with lower UTIs, the classic features are enuresis (can't control urination), frequency, dysuria, and suprapubic discomfort.

A nurse is caring for a 6-year-old girl who exhibits manifestations of a urinary tract infection but whose urine culture is negative for microorganisms. Which cause must be considered when urinary symptoms are present in the absence of bacteriuria? Select all that apply. A. Sexual molestation B. Pinworms C. Excessive cranberry juice intake D. Vaginitis E. Viral cystitis

A. Sexual molestation B. Pinworms D. Vaginitis E. Viral cystitis Urinary symptoms in the absence of bacteriuria suggest vaginitis, urethritis, sexual molestation, use of irritating bubble baths, pinworms, or viral cystitis. Cranberry juice is not a causative agent.

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? A. Smoking cessation program B. Walking program C. Increase dietary sodium intake D. DASH diet with limited caloric intake

A. 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.

A nurse is caring for an older adult client with a urinary tract infection (UTI). The nurse understands which information about UTI's in the older adult population? Select all that apply. A. The UTI may be reflected in a change in the client's mental state. B. UTI is commonly associated with severe pain. C. UTI is relatively common in older adults. D. Client may have no symptoms.

A. The UTI may be reflected in a change in the client's mental state. C. UTI is relatively common in older adults. D. Client may have no symptoms. UTIs are relatively common in older adults. Older adults may have vague symptoms such as anorexia, fatigue, weakness, or change in mental status. Even with more serious upper UTIs, the classic signs of infection such as fever, chills, flank pain, and tenderness may be altered or absent. Sometimes, no symptoms occur until the infection is far advanced.

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? A. There is possible obstruction in the urinary tract. B. The woman has multiple sexual partners. C. The woman takes too many bubble baths. D. The woman does not clean herself properly.

A. There is possible obstruction in the urinary tract. 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 assesses a client in an ambulatory care facility. Which manifestation(s) leads the nurse to advocate for investigation of possible acute pyelonephritis? Select all that apply. A. abrupt onset of fever and chills B. urinary urgency and frequency C. shortness of breath D. heart palpitations E. flank pain in the back

A. abrupt onset of fever and chills B. urinary urgency and frequency E. flank pain in the back Acute pyelonephritis tends to present with an abrupt onset of chills, high fever, and an ache or tenderness in the flank area of the back. Lower urinary tract symptoms—dysuria, frequency, and urgency—also are common. Nausea and vomiting may occur along with abdominal pain.

A nurse is caring for a client with diabetic glomerulosclerosis. The presence of which substance in the urine would be used in diagnosing this condition? A. albumin B. potassium C. sodium D. hemoglobin

A. albumin Microalbuminuria is an important predictor of future diabetic nephropathies and is evidence of glomerular damage. Normally, albumin as a large protein molecule, should not be passed through the glomerular filtration process. Microalbuminuria is defined as urinary albumin excretion of 30 to 300 mg in 24 hours. Presence of electrolytes or hemoglobin is not evidence of diabetic glomerulosclerosis.

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection. Which finding should the nurse expect? A. increased nitrites B. positive glucose C. specific gravity of 1.025 D. solid formations

A. increased nitrites Urinalysis of a client with a urinary tract infection to have increased nitrites, because bacteria reduce nitrates in the urine to nitrites. Glucose and protein are not normal findings and would require follow-up. Specific gravity of 1.025 is within normal limits; solid formations in the urine suggest calculi.

The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include: A. protein in the urine. B. decreased triglycerides. C. abnormal blood clotting factors. D. decreased low-density lipoproteins. E. serum hyperalbuminemia.

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

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate? A. The use of ACE inhibitors will increase the vasopressin levels. B. ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction. C. The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys. D. ACE inhibitors should be used strictly in those clients who also have an underlying cardiac history.

ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.

Which client is displaying manifestations of having a kidney stone?

Acute onset of colicky flank pain radiating to lower abdomen

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

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 (ARPD)

10. A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s) A) "has cancer in his stomach." B) "has cancer in the kidney that has spread most likely to his lungs." C) "will need to undergo surgery to remove both kidneys and then go on dialysis." D) "tumor can be easily treated with chemotherapy. We will start this soon."

B

3. A nurse has noted the high incidence of urinary tract obstructions of a variety of etiologies. Which of the following individuals are at risk of developing urinary obstructions? Select all that apply. A) A 43-year-old male with an acid-base imbalance secondary to malnutrition B) A 29-year-old female, pregnant for the first time C) A 69-year-old female with anemia secondary to insufficient erythropoietin production D) A 70-year-old male with benign prostatic hyperplasia (BPH) E) A 58-year-old male with renal calculi F) A 28-year-old male with a neurogenic bladder secondary to spinal cord injury

B,D,E,F

A female teenager has experienced three uncomplicated urinary tract infections in the past 3 months. Which action should the nurse include in education for this teenager? A. Proper handwashing to decrease amount of B. Pseudomonas growing on the hands B. Taking antimicrobials to treat Escherichia coli while forcing fluids C. Wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection D. Washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus

B. Taking antimicrobials to treat Escherichia coli while forcing fluids Most commonly, UTIs are caused by Escherichia coli enter through the urethra. E. coli are abundant in fecal matter. Treatment consists of a short course of antimicrobial therapy. Forcing fluids may relieve signs and symptoms and is used as an adjunct to antibiotics.

An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health care provider to avoid organ meats, certain fish, and other foods that are high in purines. This treatment would be advised for which type of kidney stones? A. Calcium stones B.Uric acid stones C. Cystine stones D. Magnesium ammonium phosphate stones

B. Uric acid stones Uric acid stones develop in conditions of gout and when high concentrations of uric acid develop in the urine. Unlike radiopaque calcium stones, uric acid stones are not visible on x-ray films. These stones develop in clients who eat a high-purine diet like Atkins.

Acute pyelonephritis is a result of:

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 ARPKD: bilateral flank masses, 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.

8. A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated? A) Goodpasture syndrome and will be treated with plasmapheresis and immunosuppressive therapy B) Membranous glomerulonephritis and should be treated with corticosteroids C) Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease D) Kimmelstiel-Wilson syndrome and should be treated with medication to control high blood pressure

C

2. One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease is A) serum creatinine levels. B) blood urea nitrogen (BUN) level. C) urine albumin excretion (UAE). D) urine specific gravity.

C) urine albumin excretion (UAE).

A nurse's neighbor is experiencing some odd symptoms, and asks the nurse about them. The neighbor states having blood in the urine intermittently and thinks there is a lump in the back (where kidney is located). What advice is most appropriate for the nurse to relay to this neighbor? A. "See if your health care provider will prescribe some antibiotics for you." B. "Do you think you might have a kidney infection?" C. "Make an appointment with your health care provider immediately." D. "Try drinking more water and see if the symptoms go away."

C. "Make an appointment with your health care provider immediately." Kidney cancer often silent, during the early states. Presenting features include hematuria, flank pain, and presence of a palpable flank mass. The tumor may reach considerable size before it is detected. Urinary tract infections may cause hematuria and drinking more water may help along with antibiotics. However, palpable lumps must always be checked by the health care provider.

A client is diagnosed with renal calcium stone formation. Which endocrine imbalances could contribute to this condition? A. Pheochromocytoma B. Cushing disease C. Hyperparathyroidism D. Hypothyroidism

C. Hyperparathyroidism Renal calculi are most commonly made of calcium. Dehydration and elevated blood calcium levels contribute to the condition. Because parathyroid hormone draws calcium from the bones into the bloodstream, hyperparathyroidism is a major contributing factor in calcium kidney stone formation.

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 glomerulonephritis is confirmed. What mechanism of damage is the most plausible? A. Injury resulting from antibodies reacting with fixed glomerular antigens or antigens planted within the glomerulus. B. Direct damage for abnormal complement activation. C. Injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. D. Direct damage from cytotoxic T-cell activation.

C. Injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane. The glomerular injury results from circulating antigen-antibody complexes that originated in the primary infection and now become trapped in the glomerular membrane. Activation of immune and inflammatory components damages the membrane but must be activated by the antibody complex.

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

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

Catheter-associated bacteriuria

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

Congenital anomalies, usually of the genitourinary system Wilms is associated with other congenital anomalies, aniridia (absence of the iris), hemihypertrophy (enlargement of one side of the face or body), and other congenital anomalies, usually of the genitourinary system. Wilms tumor usually is a solitary mass that occurs in any part of the kidney. The common presenting signs are a large, asymptomatic abdominal mass and hypertension.

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

Corticosteroids

The nurse is presenting an educational program about renal carcinoma. The nurse determines that the participants understand early signs of the disease when they identify which as an early sign or symptom? A. Palpable flank mass B. Flank pain C. Hematuria D. None of the above

D. None of the above Kidney cancer is largely a silent disorder during its early stages, and symptoms usually denote advanced disease. Presenting features of kidney cancer include hematuria, flank pain, and a palpable flank mass, but again these are usually signs and symptoms of advanced disease.

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? A. There is a large amount of extracellular material in the mesangial and subendothelial tissue of her glomeruli. B. Dense noncellular material is deposited on the endothelial and epithelial side of the basement membrane cells. C. Collagen fibers are deposited in the glomeruli. D. Podocytes encircle the outer surface of glomerular capillaries and connect to the epithelial cells.

D. Podocytes encircle the outer surface of glomerular capillaries and connect to the epithelial cells. In the healthy glomerulus, podocytes encircle the capillaries and attach epithelial cells to the basement membrane. Dense noncellular material denotes basement membrane thickening. A large amount of extracellular material in the mesangial and subendothelial tissue characterizes sclerosis. The presence of collagen fibers denotes fibrosis; all are pathologic findings.

An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which treatment goal would be considered the priority in the care of this child? A. Rehydration therapy B. Total parenteral nutrition C. Prophylactic antibiotics D. Respiratory support

D. Respiratory support Aggressive ventilatory support is often necessary for neonates with ARPKD due to the presence of pulmonary hypoplasia and hypoventilation. Hydration, nutrition, and infection prevention are relevant aspects of care, but respiratory interventions are the priority.

A pregnant woman in the third trimester reports burning and pain on urination. Which physiologic changes during pregnancy increase the risk for urinary tract infection (UTI)? Select all that apply.

Dilation of the renal calyces, pelvis, and ureters Muscle-relaxing effects of progesterone-like hormones Mechanical obstruction from the enlarged uterus

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

Extracorporeal shock wave lithotripsy (ESWL)

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

Flank pain, dysuria, and nausea/vomiting

Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis?

Group A Β-hemolytic streptococci

Which client clinical manifestation most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma?

Hematuria

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

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 2 routes 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

A young adult with a history of intermittent flank pain, repeated urinary tract infections (UTIs), and hematuria is diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which pathophysiologic abnormality most likely has contributed to the development of ADPKD?

The client has inherited a tendency for epithelial cells in the tubules to proliferate inappropriately.

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. 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.

A client is being treated with colchicine for pain in the big right toe. The client begins to complain of severe right flank pain and is diagnosed with kidney stones. Which type of kidney stone does the nurse recognize this client is most likely affected by?

Uric acid