Patho II Exam 1

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."

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

he nursing instructor, while teaching about renal function and disorders, informs the students that the most frequent form of urinary tract cancer is:

Bladder

A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescribed to help determine the cause of these new symptoms?

Blood work for hemoglobin, red blood cells, and hematocrit

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

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

Increased blood pressure

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

Increasing the normal saline intravenous infusion rate prior to the exam

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

A 40-year-old mother of three reports incontinence. Her physician suggests Kegel exercises because they strengthen the pelvic floor muscles. Kegel exercises are most likely to help which type of incontinence?

Stress incontinence

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.

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

Corticosteroids

A young adult client is currently in a rehabilitation facility following a spinal cord injury at level T2. The nurse and client are discussing long-term options for continence management. Which statement demonstrates the client has a clear understanding of the issue?

"An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications."

A neighbor is complaining to a friend (who happens to be a nurse) about several changes in her body. Which of the following complaints raises a "red flag" because it could be a sign of epithelial cell bladder cancer?

"I noticed my urine is pinkish red, but I'm not having any pain when I pee."

Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer?

"More than ever, I guess it would be worthwhile for me to quit smoking."

The client has just been diagnosed with bladder cancer and asks the nurse what causes it. What would be the nurse's best response to the client?

"The cause is unknown."

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client?

"This value indicates you are having difficulty emptying your bladder."

Urinary incontinence can be a problem with older adults. One method of treatment is habit training, or bladder training. When using this treatment with an older adult, how frequently should he or she be voiding?

2 to 4 hours

Accumulation of nitrogenous wastes such as urea in the circulatory system is an early sigh of chronic kidney disease (CKD). The nurse knows that normal levels of urea in blood are approximately:

20 mg/dL (7.14 mmol/L)

A geriatric nurse is caring for several clients. Which alterations in health should the nurse attribute to age-related physiologic changes?

A 78-year-old woman's GFR has been steadily declining over several years.

One of the many tests done during urodynamic studies is the sphincter electromyelogram. What does this test study?

Activity of the voluntary muscles of the perineal area

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

Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?

Anemia

A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?

Antihypertensive medications

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 (ARPKD)

The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply.

BUN-to-serum creatinine ratio of greater than 20:1 Increased BUN Decreased urinary output

The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal failure?

Baseline urine output of 50 mL/hr that is now 10 mL/hr

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

Catheter-associated bacteriuria

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?

Diuretic phase

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?

Diuretics

The nurse is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the nurse is most accurate?

Drink lots of fluids to help relieve the signs/symptoms of UTIs.

An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education?

Dry mouth and constipation are common.

Which dermatologic problem most often accompanies chronic kidney disease (CKD)?

Dry skin and pruritus

An older male comes to the clinic with the chief report of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. What should the nurse suspect to be the most frequent cause of this client's problem?

Enlargement of prostate gland

A client diagnosed with flaccid neurogenic bladder is taught to apply pressure with the hand above the symphysis pubis while in the sitting position. What is the expected outcome of this technique?

Fairly efficient emptying of the bladder

The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function

Glomerular filtration rate (GFR)

A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer?

Gross hematuria

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

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

Hypertension

The nurse is planning an education seminar on polycystic kidney disease. Which topic should the nurse include as a key indicator of both autosomal dominant and autosomal recessive polycystic kidney disease?

Hypertension

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

An older adult presents to the primary health care provider's office with a report of bladder leakage. Which assessment correlates with a diagnosis of stress incontinence?

Loss of small amounts of urine when laughing or sneezing

A client is diagnosed with renal failure. The nurse must monitor for failure of which functions? Select all that apply.

Maintenance of body water Electrolyte balance Acid-base balance Removal of metabolic waste from blood

A nurse suspects a client may be experiencing flaccid bladder dysfunction based on 24-hour intake and output. Which diagnostic method is most likely to confirm or rule out whether the client is retaining urine?

Measurement of postvoid residual (PVR) by ultrasound

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?

Obstruction of the renal tubules with myoglobin and damaged tubular cells

A nurse is caring for a client in spinal shock. Which intervention is appropriate in relation to the client's urinary status?

Perform intermittent catheterization

A client on peritoneal dialysis awakens one night to find that the end of the catheter has become disconnected and possibly contaminated by microbes from the bed sheets. The nurse should focus assessment on which possible complications of peritoneal dialysis? Select all that apply.

Peritonitis Hernia formation

What is the most common cancer of the kidney?

Renal cell carcinoma

A client diagnosed with chronic kidney disease (CKD) is experiencing nausea and vomiting. Which intervention would be most appropriate for the nurse to provide?

Restrict intake of dietary protein

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

Which type of bladder cancer is identified as the most rare of all the types?

Small cell carcinoma

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.

An older adult client who recently started taking furosemide tells the nurse about now experiencing problems with urine incontinence. Which type of incontinence is this client likely experiencing?

Transient

A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as:

Urge incontinence

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

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

Which clinical manifestations would tell a nurse that a client is having progressive decompensation related to obstruction of urinary outflow?

When tested for residual urine volume, 1400 mL of urine is obtained when client is catheterized.

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.

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

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

Which assessment indicates to the nurse that a client may have a spastic bladder dysfunction?

incontience

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

The nurse is providing emotional support to a client who has just been diagnosed with low-grade urothelial bladder cancer. When the client inquires about prognosis rates for this type of cancer, the nurse responds that:

it is usually noninvasive and has an excellent prognosis.

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

pericarditis

The nurse is providing dietary instruction to a client with chronic kidney disease (CKD) who will be starting hemodialysis treatments soon. The nurse will educate the client to increase the daily allowance of which macronutrient or mineral once the hemodialysis treatments begin?

protein

In which client would the nurse recognize the symptoms of a lesion in the micturition center of the sacral cord?

A trauma client whose bladder ultrasound reveals 1140 mL of urine

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 health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:

Nephrotoxic acute tubular necrosis

Which condition/disorder would the nurse see as being likely to cause the most serious long-term problems?

Polycystic kidney disease

An older adult states that he awakens at least three times each night to void. When assessing the client, what potential causative factor should the nurse prioritize?

The client takes his prescribed beta-blocker and diuretic each evening at bedtime.