Patho- Renal disorders Chapter 22/23
For which of the following conditions would the clinician need to recommend straining of the urine? Urinary tract infection (UTI) Asymptomatic bacteriuria Urosepsis Urolithiasis
Urolithiasis ...is the presence of stones. Straining of the urine helps to assess whether a stone has been passed and enables a stone to then be analyzed.
Which of the following comments by a patient shows understanding of the dietary changes that may help in interstitial cystitis? "I should probably give up or limit my morning cup of coffee." "I need to become a vegetarian." "I need to drink less water each day in order to urinate less." "Spicy food may help alleviate my symptoms."
"I should probably give up or limit my morning cup of coffee." interstitial cystitis can be aggravated by certain food choices, such as caffeine and alcohol.
A nurse is evaluating a patient's risk for renal disorders. Which of the following increase the risk for renal dysfunction? Select all that apply. A patient with diabetes mellitus A patient with severe hypertension A patient with systemic lupus erythematosus A patient with cirrhosis A patient with peptic ulcer disease
-A patient with diabetes mellitus Diabetes mellitus increases the risk for renal dysfunction -A patient with severe hypertension Hypertension can cause kidney damage -A patient with systemic lupus erythematosus Lupus can damage the kidneys
A patient is recommended for a urodynamic study. Which of the following pieces of information can be learned from this study? Select all that apply. Functioning of the bladder Postvoid volume Pyelonephritis Stones in the ureters Bladder filling and emptying
-Functioning of the bladder a urodynamic study can assess how well the bladder functions and empties. -Postvoid volume A urodynamic can assess the amount of urine remaining in the bladder after voiding. -Bladder filling and emptying a urodynamic study can measure bladder filling and emptying.
For which of the following would antibiotics be appropriate as the primary treatment? Select all that apply. Group A beta-hemolytic streptococci (GABHS) glomerulonephritis Nephrotic syndrome Pyelonephritis Goodpasture's syndrome Polycystic kidney disease
-Group A beta-hemolytic streptococci (GABHS) glomerulonephritis GABHS glomerulonephritis is a disorder caused by streptococcal bacterial -Pyelonephritis Goodpasture's syndrome is an autoimmune disorder.
A clinician needs to be able to assess a patient's suspected renal calculi. What diagnostic tools may aid the clinician? Select all that apply. IV pyelogram (IVP) procedure Cystoscopy Cough test Computed tomography (CT) scan Urinalysis
-IV pyelogram (IVP) procedure An IVP examination can show the presence of stones blocking the fluid flow -Computed tomography (CT) scan A CT scan can show the presence of stones.
Which of the following are true statements about acute glomerulonephritis? Select all that apply. Nephrolithiasis is a primary cause of acute glomerulonephritis. Patients with acute glomerulonephrititis have no dietary restrictions. Glomerular permeability is lessened, preventing filtration of the blood. In acute glomerulonephritis, blood cells and protein may appear in the urine. Streptococcal infections can result in glomerulonephritis.
-In acute glomerulonephritis, blood cells and protein may appear in the urine. -Streptococcal infections can result in glomerulonephritis.
A nurse is reviewing urinalysis results. Which factors does she review to see whether the patient has a urinary tract infection? Select all that apply. Glucose Bilirubin Albumin Leukocyte esterase Nitrite
-Leukocyte esterase -Nitrite Both will be high in urine sample if a urinary tract infection is present.
A woman is diagnosed with stress incontinence. Which of the following are risk factors for this disorder? Select all that apply. Multiple childbirths Low estrogen levels Female sex Young age Postmenopausal
-Multiple childbirths can lessens the strength of the pelvic floor muscles. -Low estrogen levels ...as occur with menopause, can cause atrophy of some structures -Female sex females are at great risk of developing stress incontinence. -Postmenopausal ...women have lower estrogen, which can result in increased urinary incontinence risk.
Which of the following would alert the clinician that the patient may have acute glomerulonephritis? Select all that apply. Pain with urination Protein in urine Oliguria Blood in urine Fluid accumulation in renal pelvis
-Protein in urine Glomerular damage can lead to protein in the urine -Blood in urine As glomeruli are damaged, blood may appear in the urine.
A patient's chart shows blood urea nitrogen (BUN) is 22 mg/dL and creatinine is 2.0 mg/dL. The nurse is asked to report the BUN-to-creatinine level. What is the correct response for the nurse to make, expressed as a ratio? Enter numeral online.
11 The BUN-to-creatine ratio is calculated by dividing BUN levels by creatine levels.
What treatment option should be considered first for George's condition? Peritoneal dialysis Antibiotics Hemodialysis Adequate fluid maintenance
Adequate fluid maintenance In prerenal acute kidney injury, maintaining adequate perfusion to the kidney is key. Thus, in George's case, adequate fluid maintenance will be required to ensure the kidneys receive enough blood flow to maintain GFR and filter wastes.
A nurse is treating a patient with kidney dysfunction. She notices that serum albumin levels are 2.8 g/dl. Which of the following is the appropriate interpretation by the nurse? Albumin levels are normal. Albumin levels are increased. Glomerular filtration rate (GFR) must be reduced. Albumin levels are decreased, due to loss in urine. Albumin levels are unaffected by renal function; thus, this value is not helpful.
Albumin levels are decreased, due to loss in urine. Normal serum albumin levels are around 3.5 to 5.4 mg/gl. Albumin can be lost in the urine with kidney damage.
A nurse is working with a patient who finds her incontinence to be very embarrassing. She is wondering if any medications are available that could help her. What class of medications does the clinician consider? Angiotensin receptor blockers Corticosteroids Anticholinergic Antileukotrienes
Anticholinergic ...block parasympathetic signals, decreasing for some patients, incontinence.
A patient passes a kidney stone. What is the most likely composition of the stone? Cystine Uric acid Calcium Magnesium
Calcium Most kidney stones are composed of calcium
A student nurse compares the symptoms of acute glomerulonephritis (AGN) with nephrolithiasis. Which symptoms should the student nurse identify as likely to be observed in a patient with AGN rather than nephrolithiasis? Select all that apply. Patient writhing in pain Cola-colored urine Ureteral colic pain Costovertebral angle tenderness Sudden edema and hematuria
Cola-colored urine Sudden edema and hematuria
A patient has unexplained hematuria with no pain. Which diagnostic follow-through may be most helpful? IV pyelogram procedure Postvoid volume measurement Straining the urine Cystoscopy
Cystoscopy A cystoscopy could be done to determine any abnormalities in the bladder that may cause bleeding.
Why are BUN and Cr levels higher than normal in George? Disruption of the buffering system Muscle breakdown is increasing serum levels of these factors Decreased GFR Antibody attack of the glomeruli have increased secretion of these substances Check Answer
Decreased GFR George's BUN and Cr are increasing because normally these substances are filtered by the kidney and partially removed from the blood. When GFR decreases, these factors increase in the blood.
Which of the following may explain George's anemia? Select all that apply. Decreased erythropoietin Not enough protein intake Anemia commonly accompanies heart failure Lack of intrinsic factor Glomerular damage
Decreased erythropoietin Glomerular damage The kidneys produce erythropoietin to maintain red blood cells levels. If the kidneys are damaged, erythropoietin levels may fall. Intrinsic factor is found in the stomach and is not altered by kidney failure. Finally, if the glomeruli are damaged, red blood cells may be filtered into the urine, leading to hematuria.
In George's condition, why is GFR lower than normal? Decreased perfusion of the kidney Elevated pressure due to hydronephrosis Blockage of the glomerular membrane by antibodies Cyst formation within the kidneys
Decreased perfusion of the kidney George's heart failure likely makes maintaining adequate perfusion of body tissues difficult. As perfusion of the kidneys declines, so does the GFR.
Why is oliguria occurring in George? Nephron cell necrosis Decreased renal perfusion and GFR Increased BUN and Cr are blocking renal filtration Cyst formation due to genetic disease is blocking renal blood flow Check Answer
Decreased renal perfusion and GFR George is experiencing oliguria for the same reason BUN and Cr levels are elevating: the kidneys are not adequately perfused. Urine is only formed when the blood is filtered. If insufficient blood is available for filtration, urine formation decreases.
A renal patient presents with edema. What may be the primary cause of this edema? Urinary stone causing backup Decreased serum albumin due to renal loss. Increased gluconeogenesis by the kidney Decreased erythropoietin synthesis
Decreased serum albumin due to renal loss. Renal dysfunction can lead to albumin loss in the urine, reducing oncotic pressure.
A patient wants to know how he can prevent future kidney stones. Which of the following is an appropriate recommendation? Drink at least 3/L per day. Take calcium supplements. Maintain current dietary choices. Take a daily prophylactic antibiotic.
Drink at least 3/L per day. Increasing hydration can help to prevent stone formation.
Why does George experience disorientation as a result of renal failure? Elevated toxin levels in the blood Anemia Hyperkalemia Elevated urine output by the kidney
Elevated toxin levels in the blood Encephalopathy may develop with acute or chronic renal failure when toxins buildup in the blood. These toxins begin to compromise brain function.
A patient with chronic renal failure reports that he is feeling like his skin is "itching." What is an appropriate response by the nurse? Suggest that the patient switch to a different cream or lotion. Suggest that the patient switch laundry detergents. Evaluate laboratory values to assess toxin levels in the blood. Suggest the patient may be developing a sensitivity to the bed linen.
Evaluate laboratory values to assess toxin levels in the blood. Buildup toxins in the blood which can occur with renal failure, may lead to a sensation of skin itching.
A patient is diagnosed with nephrotic syndrome. Which of the following does the nurse expect to observe? Decreased serum blood urea nitrogen (BUN) Fatty casts in urine Absence of edema Patient in severe pain due to stone formation
Fatty casts in urine In nephrotic syndrome, casts may appear in the urine due to nephron damage.
What is the cause of polycystic kidney disease? Genetic disorder Autoantibody attack of the glomeruli Precipitation of crystals in filtrate Elevated blood sugar
Genetic disorder
A patient has polycystic kidney disease. The nurse correctly determines which of the following is the cause? Bacterial infection Autoimmune disorder Genetic disorder Too much calcium in the diet
Genetic disorder Polycystic kidney disease is a genetic disorder.
Which of the following findings may encourage a clinician to begin considering discussing the possibility of a need for a kidney transplant? Damage to 50% of the nephrons Presence of periorbital edema Glomerular filtration rate (GFR) < 12 ml/min Protein in urine
Glomerular filtration rate (GFR) < 12 ml/min GFR should be above 90 ml/min for normal renal function. This value shows highly compromised renal function.
Which of the following conditions result from autoantibodies attacking the glomeruli? Polycystic kidney disease Pyelonephritis Nephrolithiasis Goodpasture's syndrome
Goodpasture's syndrome
Plasmapheresis would be a treatment option for a patient with which of the following conditions? Acute kidney injury End-stage renal disease Pyelonephritis Goodpasture's syndrome
Goodpasture's syndrome Plasmapheresis would remove the antibodies that cause damage in Goodpasture's syndrome.
A patient is diagnosed with Goodpasture's syndrome. Which of the following statements are true about this condition? Select all that apply. Goodpasture's syndrome is an autoimmune disease. Goodpasture's syndrome is often asymptomatic. Goodpasture's syndrome is a form of PKD. Goodpasture's syndrome is an inherited disorder. Dialysis may be required to treat Goodpasture's syndrome.
Goodpasture's syndrome is an autoimmune disease. Goodpasture's syndrome is an inherited disorder. Dialysis may be required to treat Goodpasture's syndrome.
A patient is to undergo renal ultrasound. Which of the following is the test most likely used to assess? Glomerular filtration rate (GFR) Hydronephrosis Casts Azotemia
Hydronephrosis ..is a collection of fluid in the kidney and can be detected with ultrasound.
Chronic renal failure may be associated with which of the following conditions? Select all that apply. Hypertension Diabetes Osteoporosis Staphylococcal infections Influenza infection
Hypertension Diabetes Osteoporosis
Damage to the glomeruli may result in which of the following? Select all that apply. Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria
Increased serum blood urea nitrogen Increased serum creatinine Proteinuria Hematuria Albuminuria
A nurse is speaking to a patient with nephrotic syndrome. Which recommendations will be helpful for the patient? Ingest a high protein diet (3 to 4 g/kg/day) Ingest a low-sodium diet (< 1500 g/day) Encourage overhydration Ingest a low-calorie/restrictive diet
Ingest a low-sodium diet (< 1500 g/day) A low-sodium diet is recommended for patients with nephrotic syndrome.
A nursing student is studying the progression of acute kidney injury. What is the proper order for the progression of acute kidney injury? Initial insult or injury to the kidney Kidney function decreases Diuresis with reduced concentrating ability by kidney Oliguria develops Recovery with return to normal urine concentration
Initial insult or injury to the kidney Kidney function decreases Oliguria develops Diuresis with reduced concentrating ability by kidney Recovery with return to normal urine concentration Rationale: Acute kidney injury begins with some type of insult or injury, leading to decreased kidney function. This causes oliguria, at first. This is then followed by a time of diuresis, and finally, a return of the kidney's ability to concentrate urine.
A patient complains that she feels she must urinate three times an hour or more. She says urinating helps relieve the discomfort she feels. But she says this is disrupting her life. Which of the following disorders is most likely present? Renal calculi Asymptomatic bacteriuria Interstitial cystitis Pyelonephritis
Interstitial cystitis ....causes a significant increase in frequency of urination.
A patient is taking a nephrotoxic drug. Which type of renal dysfunction is the nurse most likely concerned about developing? Prerenal Intrarenal Postrenal Juxtarenal
Intrarenal Intrarenal injury occurs with direct damage to the kidney, such as by nephrotoxic drugs.
A patient is unable to pass a renal calculi. Which of the following treatment options may the clinician consider? Insertion of medications in the bladder Lithotripsy Ingestion of a beverage formulation designed to break up the stone Immediate surgery
Lithotripsy ...uses sound waves to break up renal calculi.
A patient mentions that bladder cancer runs in his family. Which signs and symptoms may appear in this cancer? Blood in the urine with severe pain upon urination Increased urge to urinate No pain with urination, but blood appears in urine Urinating up to 50 times per day
No pain with urination, but blood appears in urine A key sign of bladder cancer is the appearance of blood in urine without pain.
A nursing educator is discussing that urinary incontinence is often under-reported. What is the primary reason for this under-reporting that nursing students should know? Urinary incontinence is extremely rare. Patients may be embarrassed to share details of incontinence. Most patients do not know what urinary incontinence is. No documentation system tracks urinary incontinence.
Patients may be embarrassed to share details of incontinence. Patients may not report urinary incontinence due to embarrassment, Clinicians should be aware of this hesitancy.
What type of edema is George likely to experience with renal failure? Pulmonary edema Periorbital edema Dependent edema Localized edema in feet
Periorbital edema Edema manifests in a number of ways in the body, but a particular form of edema, periorbital edema, may signify renal failure. The swelling around the eyes often develops with increased fluid accumulation.
For a confirmative diagnosis of Goodpasture's disease, the nurse anticipates which of the following? Glomerular filtration rate (GFR) measurement decreases. Positive immunoglobulin results. Intravenous pyelogram (IVP) shows obstruction. Urinalysis shows the presence of casts.
Positive immunoglobulin results. Goodpasture's diseases is an autoimmune disease diagnosed by the presence of antibodies.
George, age 72, recently suffered a heart attack, damaging his left ventricle. He appears to be suffering from left-sided heart failure. Stroke volume, blood pressure, and cardiac output are all reduced. George's renal function may be impaired. Serum blood urea nitrogen (BUN) and creatinine (Cr) levels are increasing and glomerular filtration rate (GFR) is significantly reduced. Oliguria is present, as is edema of the face and extremities. George seems to be becoming more confused and disoriented. Further blood laboratory values reveal hypocalcemia, hyperkalemia, and anemia. Based on the information provided, which type of renal dysfunction is most likely in George's case: prerenal, intrarenal, or postrenal? Prerenal Intrarenal Postrenal None. Based on available data, George's renal function appears normal.
Prerenal The most likely renal failure type is prerenal. Prerenal failure occurs when the kidneys are not adequately perfused. In George's case, his heart failure is likely resulting in reduced blood flow to the kidneys. The increasing levels of BUN and Cr, along with decreasing GFR, shows George's kidneys are not functioning normally.
A nursing student suspects that a patient has a lower urinary tract infection (UTI). The nursing educator, however, believes that the patient may have pyelonephritis. Which of the following signs or symptoms did the nursing educator notice that may indicate pyelonephritis? Presence of leukocyte esterase in the urinalysis results Level of pain the patient is self-reporting Presence of fever Patient's past medical history
Presence of fever Fever may be present in pyelonephritis, but is often not present in urinary tract infections.
The urinalysis results of a patient in the end stage of chronic renal failure is likely to show which of the following? Presence of white blood cells (WBCs), red blood cells (RBCs), and protein Elevated leukocyte esterase Elevated ketones Elevated nitrite
Presence of white blood cells (WBCs), red blood cells (RBCs), and protein As glomerular damage increases, substances not normally passing the filter of the glomerulus will be able to pass through and appear in the urine.
A patient states that she once took a medication that turned her urine red. What medication does the nurse think the patient is referring to? Pyridium Fluconazole Methicillin Lasix
Pyridium ...is a medication to treat the pain of urinary tract infections (UTIs), which will turn the urine a red color.
Glomerular filtration rate (GFR) is recorded as 12 ml/min. What is the correct interpretation by the nurse? Renal function has returned to normal. The patient is ready to be discharged. Renal function is not normal, as the patient is in stage 3 chronic renal failure (CRF). Renal function is above normal levels. Renal function indicates stage 5 CRF.
Renal function indicates stage 5 CRF. Normal renal function requires a GFR of 90 ml/min. The patient's level is severely reduced, placing him in stage 5 of renal disease.
A patient's glomerular filtration rate (GFR) is 110 ml/min. Which of the following interpretations is correct? Renal function is normal. The value is too high; the kidneys are not concentrating the urine. This value is too low; the patient is retaining fluids. The value is too low due to decreased renal perfusion.
Renal function is normal. A normal renal function occurs with a GFR >90 ml/min, so the patient's value would enable normal renal functions.
A patient arrives in the emergency department complaining of a kidney stone. Which of the following is the appropriate nursing intervention? Restrict all fluids. Withhold pain medications until the stone is passed. Strain urine. Offer sedative.
Strain urine. Straining the urine is important so that the stone can be captured.
Which of the following bacterial infections is most worrisome to the clinician in regards to glomerular damage? Staphylococcal Clostridial Neisseria Streptococcal
Streptococcal Streptococcal pyogenes can cause glomerulonephritis.
What is the most common cause of acute glomerulonephritis? Streptococcal infection Epstein-Barr virus Staphylococcal infection Cytomegalovirus
Streptococcal infection
A patient's chart lists the presence of incontinence. With no further information provided, which type of the incontinence is the nurse most likely to encounter in the patient? Overflow Stress Neurogenic Functional
Stress Stress incontinence is the most common type of incontinence
For which disorder may a nurse suggest Kegel exercises? Stress incontinence Asymptomatic bacteriuria Urinary tract infection (UTI) Overactive bladder
Stress incontinence Kegel exercises may be used to increase the strength of the pelvic floor muscles, decreasing incontinence.
The following assessment results for a patient are reviewed: urine culture revealed a high level of colony-forming units. Urine was cloudy in appearance and the patient reports pain with urination. No fever or other symptoms are present. What conclusion may the clinician make? Interstitial cystitis Asymptomatic bacteriuria Urinary tract infection (UTI) Bladder cancer
Urinary tract infection (UTI) Cloudy urine with pain on urination indicates a UTI if no fever is present.
A patient's urinalysis reveals the presence of glucose. Which of the following should be considered first? The patient is eating too many carbohydrates. Decreased glomerular filtration rate (GFR) is concentrating the urine too much The patient may have diabetes mellitus. The patient has kidney failure.
The patient may have diabetes mellitus. Glucose in the urine is often a sign of diabetes mellitus, not a sign of renal problems.
A critical care patient is to receive continual renal replacement therapy (CRRT). What is an appropriate description to share with family members of the patient? The patient's blood will be purified over 24 hours. CRRT is a form of hemodialysis and is done every three days. CRRT is a form of plasmapheresis and removes antibodies from the plasma. CRRT provides IV infusions due to fluid loss.
The patient's blood will be purified over 24 hours. CRRT is a continual process to purify the blood.
A patient has oliguria. Which of the following interpretations by the nurse is correct? The patient has increased urine output compared to normal. The patient has a urinary stone. The patient's urine output is less than 400 ml/day. The patient's glomerular filtration rate (GFR) must be elevated.
The patient's urine output is less than 400 ml/day. Oliguria is decreased urine output, less than 400 ml/day.
A patient is suffering declining kidney function due to an autoimmune disease. The patient asks the nurse how much of his kidney must suffer damage to lead to end stage renal disease (ESRD). Which of the following is the appropriate response by the nurse? Usually ESRD develops when less than 10% of the nephrons are damaged. Usually ESRD develops when 10% to 20% of the nephrons are damaged. Usually ESRD develops when 65% to 75% of the nephrons are damaged. Usually ESRD develops when 90% to 95% of the nephrons are damaged.
Usually ESRD develops when 90% to 95% of the nephrons are damaged. Nephron damage of approximately 90-95% will place a patient in end-stage renal failure.
Which of the following substances may be needed as a supplement for a patient suffering renal osteodystrophy? Iron Vitamin D Glucosamine Vitamin E
Vitamin D In renal osteodystrophy, a patient suffers bone breakdown due to low calcium retention by the kidneys. Vitamin D helps with calcium absorption.
Chronic renal failure (CRF)_________. appears with normal CBC and serum electrolyte levels. has a rapid and progressive onset. is always the result of prerenal kidney injury. follows five stages of progression with decreasing glomerular filtration rate.
follows five stages of progression with decreasing glomerular filtration rate.
Stone formation within the kidneys in known as _____________________. pyelonephritis polycystic kidney disease nephrolithiasis nephrotic syndrome
nephrolithiasis
