PATHO Renal
A 72-year-old client is scheduled for a kidney transplant. The nurse knows that which aspect of advanced age has a positive effect on the success of kidney transplant survival? a. Reduction in T-lymphocyte function b. Decreased muscle mass c. Acceptance of immunosuppressive therapy d. Psychological maturity
a
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: a. Acute postinfectious glomerulonephritis b. Adult-onset medullary cystic disease c. Autosomal recessive polycystic kidney disease (ARPKD) d. Acute nephritic syndrome
a
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? a. Increased fluid intake and dietary changes b. Increased physical activity and use of over-the-counter diuretics c. Regular random blood glucose testing d. Weight loss and blood pressure control
a
A client is diagnosed with renal calcium stone formation. Which endocrine imbalances could contribute to this condition? a. Hyperparathyroidism b. Cushing disease c. Pheochromocytoma d. Hypothyroidism
a
A client newly diagnosed with glomerulonephritis asks the nurse, What caused me to get this disease? Which response by the nurse is most accurate? a. Antigen-antibody complexes b. Vesicoureteral reflux c. Glomerular membrane viruses d. Catheter-induced infection
a
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 clients 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? a. Blood work for hemoglobin, red blood cells, and hematocrit b. Cystoscopy and ureteroscopy c. Blood work for white cells and differential d. Assessment of pancreatic exocrine and endocrine function
a
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? a. Increase washout of urine b. Decrease acidity of urine c. Thin mucus to prevent bacterial adherence d. Increase immune availability
a
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? a. Measurement of postvoid residual (PVR) by ultrasound b. Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate c. Routine urinalysis d. Urine test for culture and sensitivity
a
An older adult client presents with a perforation of a peptic ulcer. The nurse will monitor for signs and symptoms of which problem? a. Peritonitis b. Fecal impaction c. Vomiting
a
If an adult client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema? a. Lower extremities b. Abdomen c. Eyelids d. Hands
a
The formation of magnesium ammonium phosphate (struvite) kidney stones is directly associated with which cause? a. Urinary tract infections b. Hydronephrosis c. Hyperuricemia d. High urine calcium
a
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? a. Baseline urine output of 50 mL/hr that is now 10 mL/hr b. Baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg c. Baseline heart rate of 100 bpm that has increased to 120 bpm d. Foul smelling, cloudy urine
a
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. specific gravity of 1.025 c. positive glucose d. solid formations
a
Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome? a. Proteinuria and generalized edema b. Hematuria and anemia c. Increased creatinine with normal blood urea nitrogen d. Renal colic and increased serum sodium
a
Which factor contributes to the development of polycystic kidney disease? a. Hereditary mutations in polycystin I and II b. Multiple recurrent urinary tract infections c. A reduction in prerenal blood flow to the kidneys d. Enlargement in the basement membrane of the kidney
a
n the balance of secretions in the gastric mucosa by the parietal cells, which ion is produced to buffer the production of hydrochloric acid? a. HCO3- b. OH- c. K+ d. H2O
a
Which conditions have the potential to cause chronic kidney disease? Select all that apply. a. Glomerulonephritis b. Diabetes c. Hypertension d. Cardiomyopathy
a,b,c
The nurse is providing care for a client with a diagnosis of kidney failure. Which laboratory findings are consistent with this clients diagnosis? Select all that apply. a. Reduced calcitriol b. Albuminuria c. Hypophosphatemia d. Hypokalemia e. Hypocalcemia
a,b,e
The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? Select all that apply. a. Hypertension b. Hypophosphatemia c. Pericarditis d. Impaired platelet function e. Heart failure
a,c,e
What are appropriate interventions in the care of a client diagnosed with renal calculi? Select all that apply. a. Addressing the clients pain b. Restricting the clients oral fluid intake c. Keeping track of intake and output d. Inserting a Foley catheter e. Straining the clients urine
a,c,e
Which stresses can cause injury to the kidney glomerulus? Select all that apply. a. Immunologic b. Asthma c. Heredity d. Arthritis e. Diabetes f. Nonimmunologic
a,c,e,f
A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds: a. Only some of the glomeruli are affected. b. All glomeruli and all parts of the glomeruli are involved. c. The mesangial cells are being affected. d. Only one segment of each glomerulus is involved.
b
A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing? a. Prerenal b. Intrarenal c. Postrenal d. Systemic
b
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? a. Pulmonary edema b. Pericarditis c. Myocardial infarction d. Pulmonary embolism
b
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? a. Impotence b. Hypertension c. Asterixis d. Terry nails
b
After several months of persistent heartburn, an adult client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to be prescribed for this client's GERD? a. Weight loss and administration of calcium channel blocking medications b. Proton pump inhibitors; avoiding large meals; remaining upright after meals c. Anti-inflammatory medications; avoiding positions that exacerbate reflux; a soft-textured diet d. Surgical correction of the incompetent pylorus and limiting physical exercise
b
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. a. Urine albumin levels b. Blood urea nitrogen (BUN) c. Glomerular filtration rate (GFR) d. Serum creatinine levels
c
An adult client has been diagnosed with polycystic kidney disease. Which statement by the client demonstrates an accurate understanding of this diagnosis? a. "I had a feeling that I was taking too many medications, and now I know the damage they can do." b. "I suppose I should be tested to see if my children might inherit this." c. "I suppose I really should have paid more attention to my blood pressure." d. "Ive always been prone to getting urinary tract infections, and now I know why."
b
An ultrasound confirms appendicitis as the cause of a client's sudden abdominal pain. Which etiologic process is implicated in the development of appendicitis? a. Elimination of normal intestinal flora b. Obstruction of the intestinal lumen c. Sloughing of the intestinal mucosa d. Increased osmolality of intestinal contents
b
Crohn disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which description? a. Triangular b. Cobblestone c. Pyramidal d. Mosaic
b
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? a. Hypokalemia and metabolic acidosis b. Obstruction of the renal tubules with myoglobin and damaged tubular cells c. Development of renal stones due to stasis d. Compartment syndrome in the lower extremities
b
The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects which physiologic principle? a. Decreased glomerular permeability b. Salt and water tubular reabsorption c. Inability to concentrate urine d. Obstruction and reflux
b
The nurse recognizes that acute renal injury is characterized by which of the following? a. Irreversible damage to nephrons b. Rapid decline in renal function c. Low incidence of mortality d. Decreased blood urea nitrogen (BUN)
b
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct? a. Calcitriol blocks gastrointestinal absorption of calcium. b. Kidneys convert inactive vitamin D to its active form, calcitriol. c. Suppression of parathyroid hormone release is characteristic of CKD. d. Calcitriol stimulates release of parathyroid hormone (PTH).
b
What is the usual cause of acute pyelonephritis? a. Reflux b. Infection c. Obstruction d. Autoimmunity
b
Which clinical manifestations would you expect to see in an infant diagnosed with autosomal recessive polycystic kidney disease (ARPKD)? a. Gross hematuria and massive generalized edema b. Bilateral flank masses and impaired lung development c. Ascending urinary tract infection and vomiting d. Elevated systemic blood pressure and severe pain
b
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. a. Daily tub baths b. Careful hand washing c. Wiping from front to back after a bowel movement d. Avoiding bubble baths
b,c,d
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? a. Renal calculi b. Renal cell carcinoma c. Acute pyelonephritis d. Acute renal failure
c
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? a. Overflow incontinence b. Urge incontinence c. Stress incontinence d. Mixed incontinence
c
A client has a postvoid residual (PVR) volume of 250 mL. Which information would the nurse tell the client? a. "This is a normal value." b. "This value indicates you are emptying your bladder too completely." c. "This value indicates you are having difficulty emptying your bladder." d. "This test indicates you do not have adequate bladder control."
c
A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement? a. "The scarring on my flank where the surgery was done doesnt seem to be fading." b. "Ive decided to try eating less fat and carbohydrates than I have been." c. "Im feeling a bit under the weather these days and Im a bit feverish." d. "Ive noticed that my urine is a bit more concentrated than usual the last few days."
c
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. Wearing gloves when wiping perineum after defecation to prevent Staphylococcus aureus infection b. Proper handwashing to decrease amount of Pseudomonas growing on the hands c. Taking antimicrobials to treat Escherichia coli while forcing fluids d. Washing hands prior to inserting a tampon to minimize the risk of group B Streptococcus
c
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury? a. Intrinsic b. Postrenal c. Prerenal d. Intrarenal
c
Inflammatory bowel disease (IBD) is used to designate two related inflammatory intestinal disorders: Crohn disease and ulcerative colitis. The nurse recognizes the difference between the distribution pattern between Crohn disease and ulcerative colitis. Which pattern describes Crohn's disease? a. Continuous involvement of the colon starting at the rectum b. Development of cancer c. Skip lesions d. Primarily rectum and colon involvement
c
Manifestations of polycystic kidney disease include which of the following? a. Increase in kidney size unilaterally b. Reduction in kidney size bilaterally c. Increase in kidney size bilaterally d. Reduction in kidney size unilaterally
c
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure? a. Client with severe hypovolemia b. Client with intratubular obstruction c. Client with prostatic hyperplasia d. Client with acute pyelonephritis
c
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. Increase dietary sodium intake b. Walking program c. Smoking cessation program d. DASH diet with limited caloric intake
c
The nurse recognizes the most common cause of acute postinfectious glomerulonephritis as: a. uncontrolled diabetes with increased proteinuria. b. prolonged blockage of the ureter with a stone. c. a streptococcal infection 7 to 12 days prior to onset. d. drug-induced damage to the renal glomeruli.
c
Upon admission, a client tells the nurse that he takes aspirin every 4 hours every day. The nurse determines that this client is at risk for: a. Zollinger-Ellison syndrome b. Cancer of the stomach c. Peptic ulcer d. Crohn disease
c
Which dermatologic problem most often accompanies chronic kidney disease (CKD)? a. Hirsutism and psoriasis b. Alopecia and fungal rashes c. Dry skin and pruritus d. Petechiae and purpura
c
A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for? a. Prerenal failure b. Intrarenal failure c. Chronic renal failure d. Postrenal failure
d
A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have? a. Intrarenal failure b. Postrenal failure c. Chronic renal failure d. Prerenal failure
d
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? a. Recovery phase b. Onset phase c. Oliguric phase d. Diuretic phase
d
A client is being treated for chronic kidney disease (CKD). One of the nurses responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients? a. Elevated blood pressure will decrease pressure on the nephron with a corresponding decrease in GFR, leading to renal failure. b. Elevated blood pressure will slow the excretion of protein (proteinuria) and lead to a hypertrophic kidney. c. Elevated blood pressure will result in greater amounts of urine formation and will over-tax renal function. d. Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.
d
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? a. Magnesium ammonium phosphate b. Cystine c. Calcium d. Uric acid
d
A client is in cardiogenic shock following a massive myocardial infarction. The clients family asks the nurse, Why are the health care providers recommending dialysis since its the heart that is sick? Which response by the nurse is most appropriate at this time? a. When a person has such a large heart attack, the kidneys suffer by developing clots which interfere with urine production. b. It looks like your family member has had a blockage in the ureters for quite some time and the heart attack has made it more difficult for the blood to be filtered by the kidney. c. It looks like your loved one has been exposed to nephrotoxic drugs like a nonsteroidal anti-inflammatory drug (NSAID) prior to the heart attack. d. When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood.
d
A nurse is completing an abdominal assessment on a client suspected to have appendicitis. When the nurse applies and then releases pressure in the client's right lower quadrant, the client experiences tenderness. The nurse is documenting the presence of: a. Referred tenderness b. Periumbilical tenderness c. Perforated appendix d. Rebound tenderness
d
A nurse is teaching a client diagnosed with Crohn disease about potential complications. The most appropriate information for the nurse to include would be: a. Chronic constipation b. Difficulty swallowing c. Excessive weight gain d. Fistula formation
d
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? a. Inadequate fluid intake b. Urethral trauma c. Fluctuations in urine pH d. Reflux flow of urine
d
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? a. S. aureus b. E. coli c. P. aeruginosa d. Group A β-hemolytic streptococci
d
An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The clients admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury? a. Intermittent periods of confusion b. Excessive voiding of clear urine c. Acute hypertensive crisis d. Sharp decrease in urine output
d
Crohn disease has a distinguishing pattern in the gastrointestinal (GI) tract. The surface has granulomatous lesions surrounded by normal-appearing mucosal tissue. A complication of the pattern includes: a. Constipation b. Rectal bleeding c. Dysphagia d. Fistula formation
d
One form of renal tubular acidosis (RTA) results from aldosterone deficiency or resistance to its action, which leads to impaired reabsorption of which electrolyte? a. Potassium b. Hydrogen c. Glucose d. Sodium
d
The client who has experienced third-degree burns is susceptible to which specific type of gastrointestinal (GI) ulceration? a. Peptic b. Duodenal c. Gastric d. Stress
d
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? a. Excretion of dilute urine b. Increased urine output c. Inability to control urination d. Increase in blood pressure
d
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? a. Monitor and limit your intake of fats, especially triglycerides in your diet. b. Eat plenty of yogurt that contains protein to prevent future infection. c. Include lots of calcium in your diet to promote urinary health. d. Drink lots of fluids to help relieve the signs/symptoms of UTIs.
d
The nurse on a geriatric unit is assessing four clients. Which client is most likely to exhibit bacteriuria? a. A client whose father is known to have died of bladder cancer b. A client who will soon undergo a hysterectomy c. A male client who has had a penile implant for several years d. A client who has a urinary catheter in place due to confusion
d
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The clients GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents: a. concentrated urine. b. a need to increase water intake. c. that the kidneys are functioning normally. d. a loss of over half the clients normal kidney function.
d
A client is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding CKD are correct? Select all that apply a. Symptoms appear with 50% of nephrons lost. b. Less than 1% of population is affected. c. Onset is abrupt. d. Hypertension is a major cause. e. Renal damage is irreversible.
d,e