WEEK 6 QUIZ
Prerenal acute kidney injury may be caused by a. severe hypotension. b. glomerulonephritis. c. bilateral kidney stones. d. acute tubular necrosis.
a
The main clinical manifestation of a kidney stone obstructing the ureter is a. oliguria. b. renal colic. c. urge incontinence. d. an abdominal mass.
b
The major cause of glomerulonephritis is a. infection of the glomerular capsule secondary to a urinary tract infection. b. immune system damage to the glomeruli. c. hydronephrosis resulting from kidney stones. d. Streptococcus infection that migrates from the bloodstream to the glomerulus.
b
The microorganism that causes the vast majority of urinary tract infections is a. Klebsiella. b. Escherichia coli. c. herpes simplex virus. d. Candida albicans.
b
The most common cause of intrinsic kidney injury is _____ injury. a. glomerular b. tubular c. interstitial d. vascular
b
A primary laboratory finding in end-stage chronic renal disease is a. decreased blood urea nitrogen (BUN). b. decreased serum sodium. c. metabolic alkalosis. d. increased serum creatinine.
d
Detrusor muscle overactivity can be improved by administration of a. alpha-receptor agonists. b. botulinum toxin. c. cholinergic agents. d. nonsteroidal antiinflammatory agents.
b
Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing a. hydronephrosis. b. acute tubular necrosis. c. nephrosis. d. renal inflammation.
b
The urinalysis finding most indicative of cystitis includes the presence of a. WBCs and RBCs. b. nitrites. c. casts. d. bacteria.
b
The manifestations of acute pyelonephritis (Select all that apply.) a. are mild and insidious. b. can result in dehydration. c. often include symptoms of lower urinary tract infection. d. include fever, chills, and costovertebral angle tenderness. e. may include urosepsis.
b,c,d,e
Calcium oxylate stone formation is facilitated by a. hypercalciuria. b. hypoparathyroidism. c. low urine pH. d. protein intake.
A
One of the most common causes of acute tubular necrosis (ATN) is a. ischemic conditions. b. cytotoxic agents. c. immune reaction. d. prolonged postrenal kidney injury.
a
The disorder characterized by a neurologic lesion that affects bladder control is a. neurogenic bladder. b. detrusor inactivity. c. bladder prolapse. d. cystitis.
a
The greatest risk factor for bladder cancer is a. smoking. b. recurrent bladder infections. c. low fluid intake. d. family history of bladder cancer.
a
The most helpful laboratory value in monitoring the progression of declining renal function is a. serum creatinine. b. serum potassium. c. blood urea nitrogen. d. mental status changes.
a
The most likely cause of anemia in a patient with end-stage renal disease is a. insufficient erythropoietin. b. blood loss secondary to hematuria. c. vitamin B12 deficiency secondary to deficient intrinsic factor. d. iron deficiency.
a
The normal post-void residual urine in the bladder is a. less than 100 mL. b. 150 to 200 mL. c. 250 to 300 mL. d. none of these; no normal residual volume is identified.
a
Which condition is caused by a genetic defect? a. Acute pyelonephritis b. Hydroureter c. Incontinence d. Polycystic kidney disease
d
Which intervention has been found to retard the advancement of chronic kidney disease? a. Calcium supplementation b. Erythropoietin c. Insulin d. ACE inhibitors
d
The patient most at risk for postrenal acute kidney injury is a(n) a. elderly patient with hypertrophy of the prostate. b. middle-aged woman with bladder infection. c. young child with reflux at the ureterovesical junction. d. patient who has both hypertension and diabetes.
a
A patient injured severely in a motor vehicle accident is hospitalized with acute kidney injury as well as multiple broken bones and lacerations. When family members ask what is meant by the term 'prerenal,' the nurse responds a. "The doctors are not sure what caused your husband's acute kidney injury, but they are working to help him recover." b. "Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney." c. "Your husband's kidney injury is only the beginning of the problems that are expected, so they are being vigilant." d. "Acute kidney injury is a new term for what people used to call acute renal failure."
b
Findings that should prompt an evaluation for renal cancer include a. bacteria in the urine. b. intermittent urinary colic. c. hematuria. d. red blood cell casts in the urine.
C
A patient who has difficulty walking without assistance is incontinent of urine when help doesn't get to her quickly enough. The term for this type of incontinence is a. extraurethral. b. functional. c. urge. d. stress.
b
A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate, because a. the basement membrane becomes increasingly permeable. b. filtration exceeds secretory and reabsorptive capacity. c. excessive solute and water are lost in the urine. d. GFR declines.
d
If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues, the patient will then experience a. oliguria and sodium retention. b. infections and sepsis. c. magnesium and phosphorus loss in urine. d. polyuria and sodium wasting.
d
Signs of late chronic renal failure include (Select all that apply.) a. high-serum potassium levels. b. high-serum calcium. c. high-serum phosphorous. d. high-blood urea nitrogen. e. anemia.
a,c,d,e
Nephrotic syndrome involves loss of large amounts of ________ in the urine. a. blood b. sodium c. glucose d. protein
d
The condition associated with end-stage chronic renal disease that is the most immediately life threatening is a. azotemia. b. increased creatinine. c. hypertension. d. hyperkalemia.
d
The effect on the renal tubules during the postoliguric phase of acute tubular necrosis involves a. reconstruction of the basement membrane. b. blocking the tubule lumens by dead cells. c. making the glomeruli patent again. d. regeneration of the renal tubular epithelium.
d
Urinary retention with consistent or intermittent dribbling of urine is called a. mixed incontinence. b. enuresis. c. stress incontinence. d. overflow incontinence.
d
Which group is at the highest risk for urinary tract infection? a. Infants and children b. Sexually active women c. Adult males d. Patients taking diuretics
b
A person with acute pyelonephritis would most typically experience a. fever. b. oliguria. c. edema. d. hypertension.
A
The consequence of an upper urinary tract obstruction in a single ureter is a. kidney stone formation. b. hydronephrosis. c. dilation of the urethra. d. anuria.
B
The most common type of renal stone is a. uric acid. b. calcium. c. struvite. d. cysteine.
B
The organism most commonly associated with acute pyelonephritis is a. Streptococcus. b. Escherichia coli. c. Klebsiella. d. Enterobacter.
B
The pain that accompanies kidney disorders is called a. nephritic. b. nephralgia. c. nephrotic. d. nephronitis.
B
A person is unaware that his bladder is full of urine, but complains that he is leaking urine almost constantly. The most accurate term for this type of incontinence is a. overflow. b. stress. c. urge. d. mixed.
a
Activation of parasympathetic nerves to the bladder will cause a. bladder contraction. b. bladder relaxation. c. sphincter contraction. d. urine reflux.
a
A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be a. potassium oxalate. b. struvite. c. cysteine. d. uric acid crystals.
D
Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because a. excess potassium leaches calcium from bone. b. erythropoietin secretion is impaired. c. urea causes demineralization of bone. d. they are deficient in active vitamin D
D
It is true that polycystic kidney disease is a. always rapidly fatal. b. caused by a streptococcal infection. c. associated with supernumerary kidney. d. genetically transmitted.
D
The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is a. hematuria. b. bacteriuria. c. glycosuria. d. proteinuria.
D
The most common direct cause of acute pyelonephritis is a. urine obstruction. b. systemic bacteremia. c. urethral catheterization. d. infection by E. coli.
D
The pathophysiologic basis of acute glomerulonephritis is a. renal ischemia. b. bacterial invasion of the glomerulus. c. an anaphylactic reaction. d. an immune complex reaction.
D
A ureterocele is a. an abnormally placed ureter. b. an additional ureter. c. a cystic dilation of a ureter. d. fusion of both ureters at the bladder junction.
c
The most likely cause of acidosis in a patient with end-stage renal disease is a. insufficient filtration of bicarbonate ions at the glomerulus. b. excessive production of respiratory and metabolic acids. c. insufficient metabolic acid excretion resulting from nephron loss. d. hypoventilation secondary to uremic central nervous system depression.
c
What problem is a patient likely to experience in end-stage renal disease? a. Hypokalemia b. Polyuria and nocturia c. Uremia d. Hematuria
c
Glomerular disorders include a. pyelonephritis. b. obstructive uropathy. c. interstitial cystitis. d. nephrotic syndrome.
d
A major modifiable risk factor for nephrolithiasis is a. positive family history. b. dehydration. c. smoking. d. drinking alcohol.
B
A common component of renal calculi is a. calcium. b. cholesterol. c. creatinine. d. urobilirubin.
a
Characteristics of vesicoureteral reflux in children include (Select all that apply.) a. possibly being genetic in nature. b. often leading to recurrent urinary tract infections. c. possibly resulting in hypertension. d. usually requiring surgical intervention.
a,b,c
Renal stone formation is affected by (Select all that apply.) a. urine concentration. b. urine PH. c. metabolic/congenital conditions. d. dietary intake. e. potassium level.
a,b,c,d
The diet for a patient with chronic kidney disease (CKD) should include (Select all that apply.) a. high carbohydrates and fats. b. low sodium and potassium. c. high protein. d. low phosphorous. e. high calorie.
a,b,d,e
Urge incontinence is often because of (Select all that apply.) a. aging. b. bladder infections. c. obesity. d. prostate enlargement. e. diuretics.
a,b,d,e
Risk factors for renal carcinoma include (Select all that apply.) a. genetics. b. hypotension. c. cigarette smoking. d. obesity. e. chemicals.
a,c,d,e
Acute tubular necrosis can occur from (Select all that apply.) a. increased ammonia levels from liver failure. b. contrast dyes used for radiologic studies. c. ischemia because of hypovolemia. d. antibiotics that are nephrotoxic.
b,c,d
Cystitis symptoms include (Select all that apply.) a. CVA tenderness. b. suprapubic pain. c. dysuria. d. fever.
b,c,d
A patient has ureteral colic. The manifestation that requires immediate notification of the physician is a. severe flank pain. b. vomiting. c. pink-tinged urine. d. chills and fever.
d
Hypotension is both a cause of chronic kidney disease and a result of chronic kidney disease.
f
Infection can lead to bladder stone formation.
t
The best intervention for acute kidney injury (AKI) is prevention.
t
In addition to E. coli, a risk factor for development of pyelonephritis is a. urinary retention and reflux. b. nephrotic syndrome. c. respiratory disease. d. glomerulonephritis.
A
The most common sign/symptom of renal calculi is a. pain. b. vomiting. c. hematuria. d. oliguria.
A
The most commonly ordered diagnostic test for evaluation of the urinary system is a. KUB. b. cystogram. c. ultrasonography. d. cystography.
c
Nephrotic syndrome does not usually cause a. hyperlipidemia. b. proteinuria. c. hematuria. d. generalized edema.
C
Scrotal pain in males and labial pain in females may accompany renal pain as a result of a. associated infections. b. associated dermatomes. c. muscle tension. d. anxiety.
B
Signs consistent with a diagnosis of glomerulonephritis include a. anuria. b. proteinuria. c. red blood cell casts in the urine. d. foul-smelling urine.
B
22. The urea-splitting bacteria contribute to the formation of ________ kidney stones. a. struvite b. calcium oxalate c. uric acid d. cystine
a
Appropriate therapy for prerenal kidney injury includes a. fluid administration. b. potassium supplementation. c. fluid restriction. d. protein restriction.
a
At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema, congestive signs in the pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include a. initiation of dialysis. b. fluid restriction. c. antibiotics. d. phlebotomy.
a
Hyperlipidemia occurs in nephrotic syndrome because a. hepatocytes synthesize excessive lipids. b. lipids are not excreted in the urine. c. body fats are catabolized. d. muscles stop burning triglycerides for energy.
a
In addition to renal colic pain, signs or symptoms of ureteral stones may frequently include a. hematuria. b. postrenal renal failure. c. urinary urgency. d. proteinuria.
a
One of the most frequent causes of chronic kidney disease is a. hypertension. b. glomerulonephritis. c. chronic pyelonephritis. d. polycystic kidney disease.
a
Osteoporosis commonly occurs in patients with end-stage renal disease because of a. hyperparathyroidism. b. hypercalcemia. c. excess active vitamin D. d. phosphorous deficiency.
a
The condition characterized by oliguria and hematuria is a. acute glomerulonephritis. b. polycystic kidney disease. c. cystitis. d. renal insufficiency.
a
The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN) in hospitalized patients is a. contrast media. b. antibiotics. c. cancer chemotherapy. d. recreational drugs.
a
The oliguric phase of acute tubular necrosis is characterized by a. fluid excess and electrolyte imbalance. b. fever and diminishing cognition. c. sodium retention and potassium loss in the urine. d. magnesium and phosphorous loss in the urine.
a
The risk for contrast media-induced acute tubular necrosis (ATN) is highest in a. a 70-year-old patient with heart failure. b. a 50-year-old patient post gallbladder surgery. c. a 12-year-old patient with recurrent bladder infections. d. a 30-year-old patient with appendicitis.
a
When a patient misses two dialysis sessions numerous electrolyte imbalances resulted. The patient will likely demonstrate (Select all that apply.) a. lethargy because of metabolic acidosis and increased BUN. b. skeletal muscle weakness and possible cardiac dysrhythmias because of hyperkalemia. c. positive Chvostek and Trousseau signs because of hypomagnesemia. d. weight gain of several pounds since her last dialysis session because of hypernatremia. e. deep rapid breathing because of compensatory mechanism for metabolic acidosis.
a,b,e
Characteristics of cystitis include (Select all that apply.) a. more common in women. b. less complicated in men. c. associated with catheterization of the bladder. d. fostered by stasis of urine. e. usually resolve without treatment.
a,c,d
A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-streptococcal glomerulonephritis. When asked, "Why is my urine the color of coffee?", the nurse responds a. "Normally, red blood cells that enter the urine are taken back into the blood, but in glomerulonephritis, the kidney disease you have, they stay in the urine and make it coffee-colored." b. "Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored." c. "The bacteria that caused your sore throat have traveled to your kidneys and are causing a little damage there that allows some red blood cells to leak into your urine and make it orange-colored." d. "When parts of your kidneys stopped working, your blood kept flowing and broke some of your little blood vessels, so red blood cells are flowing into your urine and making it coffee-colored."
b
A patient, age 3, has vesicoureteral reflux. "Why does that make him have so many bladder infections?" asks his mother. The nurse's best response is a. "When he urinates, the urine makes a fluid trail to the bladder, and if he does not clean himself well, bacteria will enter and make a bladder infection." b. "When he urinates, urine runs back toward his kidneys and then into the bladder again, making it easy for bacteria to grow if they reach the bladder." c. "When he urinates, urine leaks into his bowel and bacteria from the bowel leak into the bladder, where they grow and make a bladder infection." d. "When he urinates, urine stays in his bladder and the normal bacteria that live in the bladder have a chance to grow and cause a bladder infection."
b
A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. This happens because a. hepatocyte failure decreases albumin synthesis. b. albumin is excreted in the urine. c. albumin leaks into the interstitial spaces. d. malnutrition is part of nephrotic syndrome.
b
One cause of an extrinsic renal system obstruction is a. clot. b. pelvic tumor. c. neurogenic bladder. d. papillary necrosis.
b
The defining characteristic of severe acute kidney injury is a. proteinuria. b. oliguria. c. hematuria. d. diuresis.
b
The direct cause of stress incontinence is a. the effect of aging. b. pelvic muscle weakness. c. neurologic conditions. d. detrusor muscle overactivity.
b
The infection frequently associated with development of postinfectious acute glomerulonephritis is a. pneumonia. b. throat infection. c. endocarditis. d. urinary tract infection.
b
The most frequent initial symptom of bladder cancer is a. bladder infection. b. hematuria. c. sudden incontinence. d. dysuria.
b
The type of glomerulonephritis which is most likely to result in a swift decline in renal function that then progresses to acute kidney injury is a. acute glomerulonephritis. b. crescentic glomerulonephritis. c. post-streptococcal glomerulonephritis. d. chronic glomerulonephritis.
b
Vesicoureteral reflux is associated with a. increased serum creatinine. b. recurrent cystitis. c. polycystic renal disease. d. proteinuria.
b
When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of protein," the nurse's response is based on the knowledge that a. his glomeruli have been damaged by his own immune system. b. the glomerular membrane has increased permeability. c. his liver is extremely active in synthesizing protein. d. his renal tubules are full of cellular debris.
b
A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating a. "Since he was oliguric for so long, he probably has rebound polyuria. As long as his blood pressure is stable, he is not hypovolemic, so I would not worry." b. "I am glad you noticed this change. It happened so gradually that we did not see it. We should call the doctor and get him to measure ADH." c. "His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered." d. "We had better measure his blood sugar. He may have developed diabetes, and what you see is osmotic diuresis from glucose in the urine."
c
Anemia in people who have end-stage chronic renal disease is caused by a. chronic loss of blood in the urine. b. poor appetite, with lack of iron intake. c. decreased secretion of erythropoietin. d. increased secretion of aldosterone.
c
Appropriate management of end-stage renal disease includes a. potassium supplementation. b. a high-protein diet. c. erythropoietin administration. d. a high-phosphate diet.
c
Pelvic floor muscle training is appropriate for a. overflow incontinence. b. reflux prevention. c. urge incontinence. d. functional incontinence.
c
Postrenal acute kidney injury may be caused by a. severe hypotension. b. glomerulonephritis. c. bilateral kidney stones. d. acute tubular necrosis.
c
Renal insufficiency occurs when _____ of the nephrons are not functional. a. 25% b. 50% c. 75% to 90% d. more than 90%
c
The difference between stress incontinence and urge incontinence is that stress incontinence a. occurs in women, whereas urge incontinence occurs in both men and women. b. occurs during sleep, whereas urge incontinence occurs during the waking hours. c. is caused by a pelvic floor muscle problem, whereas urge incontinence is caused by a problem with the detrusor muscle. d. is caused by a detrusor muscle problem, whereas urge incontinence is caused by a neurologic problem.
c
In patients with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease? a. Greater than 15% b. Greater than 25% nephron loss c. Greater than 50% nephron loss d. Greater than 90% nephron loss
d
The individual at highest risk of pyelonephritis who requires monitoring for signs of its occurrence is the a. woman who is paraplegic. b. woman who is pregnant. c. man who has glomerulonephritis. d. man who has chronic urinary tract infections.
d
The most common cause of ischemic acute tubular necrosis (ATN) in the United States is a. hypotension. b. hypovolemia. c. renal artery stenosis. d. sepsis.
d
The patient reports persistent pelvic pain and urinary frequency and urgency. She says the pain improves when she empties her bladder. She does not have a fever and her repeated urinalyses over the past months have been normal, although she has a history of frequent bladder infections. She also has a history of fibromyalgia and hypothyroidism. Based on her history and complaints, her symptoms are characteristic of a. neuroses. b. ureteral stone. c. neurogenic bladder. d. interstitial cystitis.
d