Nephritis Practice Questions
The nurse performs dietary teaching for a patient diagnosed with nephritis. Which patient statement leads the nurse to determine that teaching was effective? "I need to be sure to eat a high-protein food at every meal." "I will throw away my salt shaker and watch my intake of protein." "I can continue to salt my food, but I need to watch how much salt I add." "I should substitute animal proteins for plant proteins in my diet."
"I will throw away my salt shaker and watch my intake of protein." The patient diagnosed with nephritis follows a no-added-salt, low-protein diet. Eating a high-protein food with every meal would be too much protein for the affected kidneys. The patient should not add any salt to foods and should rely only on sodium naturally occurring in foods. The patient should follow a low-protein diet, from all sources (plant and animal).
A patient diagnosed with acute postinfectious glomerulonephritis is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The patient asks the nurse, "What does this medication do?" Which response by the nurse is accurate? "It will reduce the protein in your urine and slow the progression of renal failure." "It decreases inflammation." "This medication increases your blood pressure." "This medication will suppress your immune system."
"It will reduce the protein in your urine and slow the progression of renal failure." ACE inhibitors are used to reduce proteinuria and slow the progression of renal failure in acute postinfectious glomerulonephritis. Glucocorticoids decrease inflammation. Antihypertensives are also used in the management of this condition; however, they are used to treat hypertension. To control inflammation caused by acute postinfectious glomerulonephritis, the nurse will administer an immunosuppressant.
The nurse is caring for a patient who is diagnosed with nephritis. The patient states to the nurse, "I am so tired all the time. What can I do so that I'm not so tired?" Which response by the nurse is appropriate? "Keep doing your regular routine. Your fatigue will get better if you do." "Go out and socialize with people. It will help you to feel better." "Schedule short periods of activity and rest between activities." "Ask your family to provide all your care."
"Schedule short periods of activity and rest between activities." Fatigue is a common manifestation of nephritis. It is important for the patient to conserve energy. Participating in short periods of activity alternated with periods of rest is a good way to combat fatigue. It is not possible to maintain normal activity levels during an episode of nephritis because of the pathophysiology of anemia and loss of plasma proteins. Instead of going out, the patient should rest. Socializing with people puts the patient at risk for infection. The patient's family should assist with activities of daily living (ADLs), not provide all of the patient's care.
The nurse is caring for a patient with rapidly progressive glomerulonephritis (RPGN) whose healthcare provider has ordered plasmapheresis. The patient asks the nurse, "What is plasmapheresis?" Which response by the nurse is accurate? "This therapy is also called plasma infusion therapy." "It is a therapy that is done only once to rid your body of harmful toxins." "This therapy removes the plasma from your blood, washes it, and tests it." "This therapy removes damaging antibodies from your blood."
"This therapy removes damaging antibodies from your blood." Plasmapheresis is a therapy that is used to remove damaging antibodies from the patient's blood. This procedure is also called plasma exchange therapy. With this therapy, plasma and glomerular-damaging antibodies are removed and the RBCs are then returned to the patient along with albumin or human plasma to replace the plasma removed. In plasmapheresis, the plasma is not washed and tested; damaging antibodies are removed.
The nurse is caring for a patient diagnosed with Goodpasture syndrome. The patient recently underwent plasmapheresis for treatment of this condition and has petechiae and bruising to the abdomen and face. Which potential complication should the nurse suspect is occurring in the patient? Alteration of immunity Alteration of coagulation Alteration of skin integrity Alteration of fluid volume
Alteration of coagulation This patient is likely experiencing an alteration of coagulation, because petechiae and bruising are manifestations of altered coagulation. Petechiae and bruising are not manifestations of alterations in skin integrity, immunity, or altered fluid volume.
The nurse is caring for a patient suspected of having postinfectious glomerulonephritis. Which laboratory test should the nurse examine to confirm the diagnosis? Blood urea nitrogen (BUN) Serum creatinine level Antistreptolysin O (ASO) titer Serum electrolytes
Antistreptolysin O (ASO) titer Postinfectious glomerulonephritis occurs 10 to 14 days following an infection of group A beta-hemolytic streptococci. The ASO titer detects streptococcal exoenzymes in the blood. Presence of these enzymes supports the diagnosis of postinfectious glomerulonephritis. BUN, serum creatinine, and serum electrolytes may be used to evaluate kidney function.
A patient states to the nurse, "My mother had nephritis, and I don't want to get it. What is one of the biggest risk factors for this disease?" Which response by the nurse is accurate? High-sugar diet Urinary incontinence Diabetes mellitus Low blood pressure
Diabetes mellitus Patients diagnosed with diabetes are at greater risk for developing nephritis because diabetes can damage the vessels of the nephron, leading to nephritis. Urinary incontinence and foods high in sugar are not associated with nephritis. A history of high, not low, blood pressure would place the patient at greater risk for developing nephritis because hypertension can damage the vessels of the nephron, leading to nephritis.
The nurse assesses a patient suspected of having postinfection glomerulonephritis. Which assessment finding leads the nurse to determine that the suspected diagnosis is correct? Glucosuria Hematuria Muscle spasms ECG abnormalities
Hematuria Acute postinfection glomerulonephritis occurs 10 to 14 days after the initial infection. A clinical manifestation of acute postinfection glomerulonephritis includes hematuria (blood in the urine). The patient will not have glucosuria (glucose in the urine), muscle spasms, or ECG abnormalities, because these are not associated with acute postinfection glomerulonephritis.
The nurse is caring for a patient who presents with a hypertensive crisis. The healthcare provider suspects that the patient has nephritis. Which factor in the patient's health history should the nurse suspect as being related to the possible diagnosis of nephritis? Muscle wasting Upper back and shoulder pain Weight loss of 10 pounds over the last 2 months History of a nonhealing skin infection
History of a nonhealing skin infection A patient with a history of a nonhealing skin infection may have a history of an infection of Streptococcus, the infectious agent that can cause nephritis. The patient with nephritis would have a history of weight gain, not loss, due to the retention of sodium and water. The patient suspected of having nephritis would not have muscle wasting and would complain of abdominal or flank pain, not upper back or shoulder pain.
The nurse is creating a plan of care for a patient diagnosed with nephritis. Which nursing diagnosis is appropriate for the nurse to assign? Fluid Volume: Deficient, Risk for Overweight Infection, Risk for Cardiac Output, Decreased
Infection, Risk for Impaired renal function puts the patient at risk for infection. Immunosuppressive drugs may mask the presence of infection. The patient with nephritis can have excess, not deficient, fluid volume. In addition, the patient with nephritis may be underweight, rather than overweight, due to dietary restrictions necessary to treat the disease. Nephritis does not cause decreased cardiac output.
An older adult patient is diagnosed with nephritis and heart failure (HF). Which assessment finding should the nurse expect to be present in this patient? Infiltrate on chest x-ray Flank pain Purulent sputum Midabdominal pain
Infiltrate on chest x-ray A patient with nephritis who has a preexisting condition such as HF may present with infiltrate on a chest x-ray. This finding indicates pulmonary edema and excess fluid volume. Midabdominal pain and flank pain may also be present; however, these are classic symptoms of nephritis and are not unique to a patient with a preexisting condition. Purulent sputum is pus in the sputum, which indicates an infection in the lungs, not HF, and is not typically present.
The nurse is providing teaching to a patient diagnosed with Goodpasture syndrome. Which information is appropriate for the nurse to include in the teaching? It may cause hemoptysis. It is caused by an infection. It may cause glycosuria. It is a result of systemic lupus erythematosus (SLE).
It may cause hemoptysis. Goodpasture syndrome is a rare autoimmune disorder of unknown etiology. In addition to causing renal symptoms (leading to renal failure), it may cause pulmonary symptoms such as hemoptysis. This is due to antibodies that may bind to alveolar basement membranes, damaging alveoli and causing pulmonary hemorrhage. Acute postinfectious glomerulonephritis (APIGN) results from infection. Goodpasture syndrome causes proteinuria and hematuria but not glucosuria. Lupus nephritis is a result of systemic lupus erythematosus (SLE).
The nurse is caring for a patient with nephritis who also has ascites due to excess fluid volume. Which intervention by the nurse is the best way to monitor the patient's degree of ascites? Measuring central venous pressure (CVP) Measuring abdominal girth Monitoring blood pressure Monitoring intake and output
Measuring abdominal girth While all choices are aimed at monitoring the patient's fluid balance, measuring the patient's abdominal girth is the only intervention that specifically addresses changes in ascites.
The nurse is caring for a patient diagnosed with nephritis. Which intervention should the nurse implement to help maintain the patient's fluid volume balance? Offering frequent mouth care for the patient Encouraging fluid consumption Increasing protein consumption Having the family bring in favorite foods and drinks for the patient
Offering frequent mouth care for the patient The patient diagnosed with nephritis is most likely on fluid restriction. Frequent mouth care should be offered to relieve the patient's thirst. Fluids are limited, not encouraged. Families may bring in a patient's favorite foods, but they should understand the fluid restriction.
The nurse is caring for a patient diagnosed with nephritis. Which intervention should the nurse implement? Turning the patient every 4 hours Rubbing the patient's skin vigorously with lotion Padding bony prominences with sheepskin Placing the patient's legs in a dependent position
Padding bony prominences with sheepskin Bedrest is required for the acute phase of nephritis. To prevent skin breakdown, the nurse should pad bony prominences with sheepskin to protect the skin, turn the patient every 2 hours (not every 4 hours), and lightly (not vigorously) apply lotion to keep the skin moist. Dependent areas are prone to breakdown, so the patient's legs should not be placed in a dependent position.
The nurse is teaching a pregnant patient diagnosed with lupus nephritis about risks that might occur during pregnancy. Which risk should the nurse include? Preeclampsia Postterm delivery Low-birth-weight infant Greater likelihood of cesarean birth
Preeclampsia Pregnant patients diagnosed with lupus nephritis have an increased risk of preeclampsia and preterm, not postterm, delivery. Increased risk of low-birth-weight infants and cesarean birth have not been shown to occur with lupus nephritis.
The nurse is reviewing the medications of an 89-year-old patient diagnosed with nephritis. Which medication class should the nurse suspect might have contributed to the development of nephritis? Beta blockers Proton pump inhibitors Serotonin reuptake inhibitors (SSRIs) Insulin
Proton pump inhibitors Proton pump inhibitors and antibiotics are two classes of drugs that are known to increase the risk of acute interstitial nephritis in older adults. Beta blockers, SSRIs, and insulin are not known to cause nephritis.
The nurse caring for a patient with nephritis is creating a plan of care to help the patient maintain nutritional balance. Which intervention should the nurse include? Providing a diet high in protein Providing large portions of food that appeal to all ages Providing a diet with large portions of meat and dairy Providing an opportunity for the family to bring food from home
Providing an opportunity for the family to bring food from home To promote adequate nutritional balance, the nurse should provide a diet with no added salt and low protein. To increase the patient's appetite, the nurse should allow opportunity for family to bring food from home. The nurse should serve age-appropriate quantities to children. In addition, diets with a large amount of dairy and meat have too much protein, which is contraindicated in nephritis.
The nurse is performing discharge teaching for a patient diagnosed with nephritis. Which lifestyle alteration is most important for the nurse to include in the teaching? Engaging in aerobic exercise daily Screening visitors for upper respiratory infections Assisting the patient to find a caregiver who can perform all the patient's care Having the patient drink eight to ten 8-ounce glasses of water daily
Screening visitors for upper respiratory infections Impaired renal function puts the patient at risk for infection. Upper respiratory infections are common and may be caused by beta-hemolytic strep (a cause of nephritis). Screening visitors will protect the patient and limit further kidney impairment. Fatigue is another problem encountered with nephritis. Patients should be instructed to rest and conserve energy. While the patient might need assistance with activities of daily living (ADLs), the patient should be encouraged to participate in the care as much as possible to maintain independence. Fluids are normally restricted in nephritis.
The nurse is teaching the parents of a child diagnosed with nephritis about measures to promote nutritional balance in the child. Which strategy should the nurse include in the teaching? Having the child eat meals alone Serving the child increased amounts of fluids Serving age-appropriate quantities of food to the child Encouraging the child to finish all the food on the plate for meals
Serving age-appropriate quantities of food to the child Anorexia presents the greatest challenge in meeting the nutritional requirements of a child diagnosed with nephritis. To increase the child's appetite, parents should serve age-appropriate portions of food and serve the child's favorite foods. Having the child eat meals with family members or friends will encourage the child to eat more. Fluids are restricted with nephritis, so increasing fluids are contraindicated. Insisting that a child finish all food on the plate is never a good idea.
The nurse caring for several patients is reviewing all laboratory results. Which patient should the nurse monitor for manifestations related to a possible diagnosis of glomerulonephritis? The patient with decreased erythrocyte sedimentation rate (ESR) The patient with decreased blood urea nitrogen (BUN) The patient with decreased serum creatinine The patient with decreased urine creatinine
The patient with decreased urine creatinine The nurse would pay particular attention to the lab values that are altered in nephritis. Urine creatinine is decreased when renal function is impaired because creatinine is not effectively eliminated from the body. The ESR is a general indicator of inflammatory response and is increased, not decreased, in glomerulonephritis. Glomerular diseases interfere with filtration and elimination of urea nitrogen, causing blood levels of BUN to rise. Increased serum creatinine levels occur with renal impairment, such as in glomerulonephritis.
The nurse is caring for a patient diagnosed with nephritis. Which assessment should lead the nurse to determine that treatment is successful? The patient's urine output is 100 mL/hr. The patient has a small (3-cm) sore on the right heel. The patient has gained 5 pounds since admission. The patient's temperature is 101°F.
The patient's urine output is 100 mL/hr. Treatment for nephritis is deemed effective when the patient regains normal urine output. The sore on the heel indicates impaired skin integrity, the weight gain signals fluid retention, and the increased temperature indicates that the patient might have an infection.
The community health nurse is planning to teach a group of patients about the etiology, risk factors, and prevention of nephritis. Which group of patients would best benefit from this teaching? Patients who are pregnant Patients diagnosed with prostate cancer Patients diagnosed with asthma Patients with sickle cell disease
The patients who would best benefit from this teaching are those at greatest risk for developing nephritis. Those at greatest risk include patients with diabetes, sickle cell disease, and congestive heart failure (CHF). Pregnancy, asthma, and prostate cancer do not increase the risk for developing nephritis.
The nurse admits a patient suspected of having nephritis. Which collaborative intervention should the nurse expect to implement? Urinalysis Complete blood count (CBC) Chest x-ray CT scan
Urinalysis Urinalysis provides information about the color, character, and odor of the urine, all important in the diagnosis of nephritis. CBC, chest x-ray, and CT scan are not part of the initial assessment for nephritis.
