patho phys 24-25
Which client is displaying manifestations of having a kidney stone?
Acute onset of colicky flank pain radiating to lower abdomen
A nurse is evaluating a client's morning laboratory values. Which result requires that the nurse notify the health care provider?
Creatinine: 10.6 mg/dL (937.04 µmol/L)
Which laboratory findings would the nurse anticipate in a client diagnosed with nephritic syndrome?
Elevated urine protein level (>3.5 g/day) and hypoalbuminemia
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.
The nurse has delegated obtaining a urine specimen for testing to the nursing assistant. What does the nurse emphasize the assistant should do to ensure accuracy of testing?
Obtain a freshly voided specimen.
Select the manifestations of renal cell carcinoma. Select all that apply.
Often silent in the early stages Hematuria Palpable flank mass
A young adult client 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 past 2 weeks?"
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 expresses frustration at the inconvenience of having to collect urine for an entire day and night as part of a prescribed 24-hour urine collection test. The client asks the nurse, "Why is this test necessary since I gave a single urine sample 2 days ago?" How could the nurse best respond to this question?
"Often when an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much is present in your urine."
A client is scheduled for a creatinine clearance test to measure the glomerular filtration rate (GFR). The client asks the nurse what this test is used for. What is the nurse's best response?
"This test provides a gauge of renal function."
A new client on hemodialysis is watching his blood being filtered through a dialyzer. He asks the nurse how much blood typically passes through the kidney every minute? The nurse responds:
1000-1300 mL/minute.
When teaching a class of nursing students, the pathophysiology instructor asks, "What is the majority of energy used for by the kidney?" Which response is most accurate?
Active sodium transport mechanisms.
The nurse is educating a client about renal disease. Which percentage of cardiac output perfuses the kidneys?
22% to 25%
A nurse is monitoring a client with renal failure. What glomerular filtration rate (GFR) would the nurse estimate if the creatinine clearance test result is 60 mL/min (1 mL/s/m2)?
60 mL/min
Urine is an amber, light-yellow fluid that is 5% dissolved solid. What percent of it is water?
95%
Which individual is at the highest risk of developing a urinary tract infection (UTI)?
A 30-year-old woman with poorly controlled diabetes mellitus
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
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 with a traumatic amputation of the lower leg has lost >40% of blood volume and is currently not producing any urine output. The nurse bases this phenomena on which humoral substance that is responsible for causing severe vasoconstriction of the renal vessels?
Angiotensin II and antidiuretic hormone
The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as:
Autosomal recessive
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.
Avoiding bubble baths Wiping from front to back after a bowel movement Careful hand washing
What is the most common cancer of the kidney?
Renal cell carcinoma
Acute pyelonephritis is a result of:
Bacterial infection
The nurse is performing palpation of the kidney during assessment of the client on the urology unit. The nurse plans to palpate in which area?
Between the 12th thoracic and 3rd lumbar vertebrae
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
Hospitalized neonates are at greatest risk of developing septicemia related to which procedure?
Catheter-associated bacteria
The nurse is assigned multiple clients with anemia. Which client may be experiencing a failure of the body to produce erythropoietin and thus may require supplemental injections of this hormone?
Client with history of chronic kidney failure
Which occurrence is most likely to cause increased urination?
Decrease in antidiuretic hormone
Which 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 procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?
Extracorporeal shock wave lithotripsy (ESWL)
Urine specific gravity is normally 1.010 to 1.025 with adequate hydration. When there is loss of renal concentrating ability due to impaired renal function, low concentration levels are exhibited. When would the nurse consider the low levels of concentration to be significant?
First void in morning
Several clients in clinic today are reporting urinary signs/symptoms. Which reported manifestation(s) leads the health care provider to suspect acute pyelonephritis? Select all that apply.
Flank pain in the back Abrupt onset of fever and chills Urinary urgency and frequency
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
Signs of nephrotic syndrome include proteinuria, edema, hyperlipidemia, and:
Hypoalbuminemia
The nurse is teaching a group of nursing students about antidiuretic hormone. The nurse should include which point about the site of ADH production in the discussion?
Hypothalamus
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 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
To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. Which rationale for this treatment is the most likely?
It removes water from the filtrate and returns it to the vascular compartment.
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
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.
Low-set ears Epicanthic folds (skin of the upper eyelid) are present Receding chin
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
What are contributing factors of acute postinfectious glomerulonephritis? Select all that apply.
May result from impetigo. Occurs after infection of group A-hemolytic streptococci. Primarily infects the pharynx.
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 nurse is explaining the role of endothelial cells in synthesizing vasoactive substances, one of which nitric oxide. What affect does nitric oxide have on renal blood flow?
Opens the renal vessels to increase blood flow
A client diagnosed with Goodpasture syndrome would require which therapy to remove proteins and auto-antibodies from the system?
Plasmapheresis
The anemia that occurs with end-stage kidney disease is often caused by the kidneys themselves. What loss of function in the kidney results in anemia of end-stage kidney disease?
Produce erythropoietin
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
The nurse is teaching a group of nursing students about the major functions of the kidney. What should the nurse include in the discussion? Select all that apply.
Removal of excess electrolytes Removal of waste products Elimination of water
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.
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 intake and output
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.
The nurse is caring for a client with kidney disease who has an estimated glomerular filtration rate of 75 mL/minute. The nurse interprets this data in which way?
The client has reduced glomerular filtration, reflecting damage to the kidney.
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 nurse is teaching an anatomy and physiology class to a group of nursing students. When discussing the juxtamedullary nephrons, it is correct to relate which function to the students?
The function of the juxtamedullary nephrons is to concentrate urine.
Which function of the kidneys helps to maintain the pH balance in the body?
The kidneys conserve base bicarbonate and eliminate hydrogen ions.
The nurse is caring for a client who has produced an average of 20 mL/hour for the previous day. The nurse recognizes this compares in which way to the normal urine output?
The kidneys should produce about 1.5 L of urine each day.
A nurse is caring for a child with Wilms tumor, stage I. Which statements are true regarding this diagnosis? Select all that apply.
The tumor is limited to the kidney and can be excised with the capsular surface intact. Prognosis is good with treatment.
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.
The nurse is teaching a group of nursing students about the mechanism of action of common diuretics. What best reflects the mechanism of these drugs?
They block the reabsorption of sodium and chloride in the nephron.
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
An older adult man reports recent urinary hesitation and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which clinical manifestations would the health care provider expect prior to the resolution of this health problem?
Urinary frequency and urgency and pain
The nurse administers the drug vasopressin to a client with a pituitary disorder. Based on knowledge of pathophysiology, the nurse anticipates the client will react in which way?
Water will be retained and decreased urine output will result.
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 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
In the emergency department, a client arrives following a car accident. His pulse is 122; BP 88/60; respiration is 18 bpm. Urine output is 4 mL over the first hour on arrival. When in shock, this lower urine output is primarily due to:
innervation of the sympathetic nervous system, causing constriction of the afferent arteriole.
The nurse and nursing student are caring for a client with a condition causing deficiency of ADH. The nurse recognizes that the student understands the origin of this process when the student states ADH is produced in which area?
pituitary gland
A nursing student studying pharmacology is learning how angiotensin converting enzyme inhibitors (ACE) work. The student is correct when stating that the mechanism of action of ACE inhibitors is to:
prevent conversion of angiotensin I to II.
The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include:
protein in the urine.
An older adult man is brought into the clinic by his daughter, who states, "My father hasn't been himself lately. Now I think he looks a little yellow." What test would the nurse expect to have ordered to check this man's creatinine level?
serum creatinine
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
A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is:
the damaged kidney is unable to produce erythropoietin.
Which substance is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms?
water
A client's urine results reveal proteinuria and microalbuminuria. The health care provider is likely to prescribed an examination that will assist in quantifying the amount of protein loss by the kidney. For which examination should the nurse prepare to educate the client?
24-hour urine test
A nurse has misread a drug prescription and given mannitol orally rather than parenterally. After reporting this to the health care provider, which assessment finding will the nurse notice as an adverse reaction to giving this drug by the incorrect route?
Abdominal bloating and watery, loose stools
The nurse is caring for a client who delivers a stillborn child due to bilateral total agenesis of the kidneys. Which physical features will the newborn exhibit that correlate with this diagnosis? Select all that apply.
Eyes widely separated with epicanthic folds Low-set ears Broad and flat nose
The nurse and nursing student are caring for a client with kidney dysfunction who requires a test to determine glomerular filtration rate. The nurse recognizes that the student understands the test when the student states:
I will need to start a 24-hour urine collection.
The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. What is the most appropriate response by the nurse?
In renal disease, vitamin D is unable to be transformed to its active form.
The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?
Increased blood pressure
The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function?
Increased creatinine and blood urea nitrogen (BUN) levels
Which client's laboratory result would be associated with abnormalities in kidney function? Select all that apply.
Increased creatinine levels Detectable levels of glucose in a urine sample Elevated cystatin C level
It is known that high levels of uric acid in the blood can cause gout, while high levels in the urine can cause kidney stones. What medication competes with uric acid for secretion into the tubular fluid, thereby reducing uric acid secretion?
asprin
The nurse is reviewing the results of a renal client's laboratory results. This client's urine specific gravity allows the nurse to assess the kidneys' ability to:
concentrate urine
The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response?
corticosteroids
When caring for the client with proteinuria, the nurse recognizes that dysfunction in which structure of the kidney allows protein to leak into the urine?
glomerulus
A client has been taking up to 2400 mg of ibuprofen per day for chronic pain following a motor vehicle accident. The client is diagnosed with chronic analgesic nephritis. The client states, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the client'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."
When teaching the client with gout about the cause of the disease, which cause should the nurse relate?
Increased levels of uric acid in the blood cause gout.
A nurse is caring for a client with diabetic glomerulosclerosis. The analysis is reviewed for the presence of which manifestation?
albumin
