Chapter 33: Disorders of Renal Function

The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit bacteriuria?

A client who has a urinary catheter in place due to confusion

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 client with systemic lupus erythematosus (SLE). The client asks why a urinalysis is necessary. The best answer is that a urinalysis would determine whether which factor was present in the urine?

Blood or protein

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

Manifestations of polycystic kidney disease include which of the following?

Increase in kidney size bilaterally

A nurse is teaching a student about nephrotic syndrome. Which statement(s) about the pathogenesis of nephrotic syndrome is accurate and should be included in the education? Select all that apply.

Increased glomerular membrane permeability allow proteins to escape from the plasma into glomerular filtrate. Massive proteinuria is a result of the increased permeability. Loss of colloidal osmotic pressure causes generalized edema.

Which statement best describes nephronophthisis-medullary cystic kidney disease?

Presence of a variable number of cysts usually restricted to the corticomedullary border.

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 good with treatment The tumor is limited to the kidneys and can be excised with the capsular surface intact

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

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

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 Keeping track of I&O

A nurse is caring for a client with renal cell cancer. What is the treatment of choice for this condition?

Surgical resection

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

Which client is likely at the greatest risk of developing a urinary tract infection?

A 79-year-old client with an indwelling catheter

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

Autosomal recessive

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."

Which pathophysiologic changes are associated with nephrotic syndrome? Select all that apply. A. Glomerular damage B. Increased plasma oncotic pressure C. Hypoproteinemia D. Compensatory synthesis of proteins by the liver E. Hypolipidemia

A. Glomerular damage C. Hypoproteinemia D. Compensatory synthesis of proteins by the liver

Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?

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

A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:

Acute postinfectious glomerulonephritis

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

A client who developed acute pyelonephritis asks the nurse what may have caused the infection. Which information will be included in the nurse's response? Select all that apply.

Acute pyelonephritis is caused by bacterial infection. Escherichia coli is the causative agent in about 80% of cases. Outflow obstruction, catheterization, and urinary instrumentation cause the complicated, acute form.

An newborn has been diagnosed with renal agenesis. Which characteristics should the nurse mention to the parents as it correlates to this diagnosis? Select all that apply. A. Eyes are situated very close together B. Epicanthic folds (skin of the upper eyelid) are present C. Low-set ears D. Long, narrow nose E. Receding chin

B. Epicanthic folds (skin of the upper eyelid) are present C. Low-set ears E. Receding chin

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

Which client would the nurse consider having the highest risk for developing a urinary tract infection?

Client with obstructed urinary outflow from a kidney stone

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.

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?

Encapsulated

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?

Enuresis

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.

Flank pain in the back Abrupt onset of fever and chills Urinary urgency and frequency

The nurse is caring for a client with cystitis. Which sign/symptom is most characteristic of the urine associated with cystitis?

Foul smell

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

Gout

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

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

Which factor contributes to the development of polycystic kidney disease?

Hereditary mutations in polycystin I and II

Which medication does the nurse administer that will lower urinary calcium by increasing tubular reabsorption to prevent kidney stone formation?

Hydrochlorothiazide

Signs of nephrotic syndrome include proteinuria, edema, hyperlipidemia, and:

Hypoalbuminemia

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

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.

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

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

Magnesium ammonium phosphate

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 Lipiduria Generalized edema Hyperlipidemia

Select the manifestations of renal cell carcinoma. Select all that apply.

Often silent in the early stages Hematuria Palpable flank mass

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

A woman has sought care because of recurrent urinary tract infections that have been increasing in both frequency and severity. Which factor is likely to contribute to recurrent UTIs?

Reflux flow of urine

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?

Respiratory support

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

Salt and water tubular reabsorption

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

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

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.

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 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

One of the most damaging effects of urinary obstruction on kidney structures is which effect?

Urinary stasis

The formation of magnesium ammonium phosphate (struvite) kidney stones is directly associated with which cause?

Urinary tract infections

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

A teenager has been admitted with the diagnosis of Alport syndrome. The client has been passing large amounts of blood in the urine. Knowing that this disorder is inherited and associated with other abnormalities, the nurse should focus assessment on which area?

Visual disturbances and hearing loss

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

a streptococcal infection 7 to 12 days prior to onset.

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?

albumin

What is the most common cancer of the kidney?

renal cell carcinoma

A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to:

saturation of urine with calcium salts.

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."

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?

"Make an appointment with your health care provider immediately."

A client who has had recurrent urinary tract infections asks the nurse about the old wives' tale of drinking cranberry juice daily. Which response by the nurse is most accurate?

"Research suggests cranberry juice will reduce bacterial adherence to the lining of the urinary tract."

A client with diabetes has laboratory results that indicate the presence of microalbuminuria. Which priority self-care measures should the client's care team prescribe for this client?

diet, exercise, and prescriptions to lower blood pressure below 140/80 mm Hg

A client is concerned that medication may damage the kidneys. Which factors place the client 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) Age/young adult

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

A client newly diagnosed with glomerulonephritis asks the nurse, "What caused me to get this disease?" Which response by the nurse is most accurate?

Antigen-antibody complexes

An adult female client has been diagnosed with cystitis. Which symptoms reported by the client does the nurse recognize are significant for cystitis? Select all that apply.

Burning and pain with urination Frequency of urination Lower abdominal and back discomfort

A client has a dilated renal pelvis due to obstruction of urine outflow from the kidney. The pressure of filtrate formation is damaging the renal structures. Which condition is most likely?

Hydronephrosis

A client is diagnosed with renal calcium stone formation. Which endocrine imbalances could contribute to this condition?

Hyperparathyroidism

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.

Although the distal portion of the urethra often contains pathogens, the urine formed in the kidney and found in the bladder are usually sterile because of which physiologic principle?

Washout phenomenon

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

Acute pyelonephritis is a result of:

bacterial infection

The nurse is reviewing the laboratory results for a client. Which laboratory findings would the nurse correlate with nephrotic syndrome?

elevated urine protein level (>3.5 g/day) and hypoalbuminemia

A client has been diagnosed with an uncomplicated urinary tract infection (UTI) for the second time in a year. Which teaching will the nurse include to prevent the most common cause of recurrent uncomplicated UTIs?

hygiene practices to reduce exposing the urethral meatus to Escherichia coli

The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection (UTI). Which finding should the nurse report as evidence of a UTI?

increased nitrites

What is the usual cause of acute pyelonephritis?

infection

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?

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

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?

Microalbuminuria is a predictor of future nephropathies.

A client has recently undergone diagnostic testing for possible Berger disease. The nurse caring for this client would anticipate the primary clinical manifestations to include which findings? Select all that apply.

Gross hematuria Recent upper respiratory infection Fever, chills, and general body aches