Question 1

A pediatric unit will be receiving an 8-day-old infant with a suspected congenital renal disorder. Which of the following renal abnormalities could be the possible cause? Select all that apply.

Accepted Answer

Renal hypoplasia, cystic dysplasia, and horseshoe kidney are more common diagnoses in infants. Renal cell carcinoma is not a congenital condition or one that often manifests in infancy. Urine-filled dilation of renal pelvis associated with atrophy of the kidney is a description of hydronephrosis.

Question 2

A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis?

Accepted Answer

ADPKD is an inherited condition, and the etiology is thought to involve cysts arising in segments of the renal tubules from a few epithelial cells that proliferate abnormally.UTIs are consequent, not causative, of the condition. Severe hypertension and portal hypertension are more commonly associated with ARPKD than ADPKD. Kidneys are typically oversized in ADPKD, and renal calculi are not noted sequelae.

Question 3

One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease is

Accepted Answer

Serum creatinine levels have not been found to be an effective predictor marker for worsening ADPKD, but urine albumin excretion (UAE) has been determined a reliable predictor, as have increased electrolytes and hematuria.

Question 4

A nurse has noted the high incidence of urinary tract obstructions of a variety of etiologies. Which of the following individuals are at risk of developing urinary obstructions? Select all that apply.

Accepted Answer

Pregnancy, BPH, renal calculi, and neurogenic bladder are all identified contributors to urinary obstructions. Acid-base imbalances and impaired erythropoietin production are health problems with renal involvement but are less likely to contribute to urinary obstruction.

Question 5

A 73-year-old man presents to his family physician with complaints of recent urinary hesitation and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which of the following clinical consequences would his care provider expect prior to the resolution of his health problem?

Accepted Answer

Pain and the distention of the distal ureter would be expected manifestations of BPH. Renal calculi, cysts, glomerulonephritis, and nephrotic syndrome are unlikely to develop consequentially, and unilateral hydronephrosis is unlikely, given that the obstruction is below the level of the ureterovesical junction.

Question 6

A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement?

Accepted Answer

Renal calculi have a complex etiology that includes diet, but also many other metabolic and endocrine factors, among others. Genetics are not identified as a contributor, and mineral intake is not likely to be the sole factor. Stone formation is normally unilateral.

Question 7

Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?

Accepted Answer

Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man.

Question 8

A client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable? Select all that apply.

Accepted Answer

Individuals with calcium oxalate stones often need to avoid high-oxalate foods like nuts, cocoa, and chocolate. Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger renal calculi. It would not be necessary to avoid calcium intake, and fluid intake should encouraged, not curbed. Medications can reduce the potential for stone formation but are not a common treatment modality.

Question 9

Which of the following individuals is at the highest risk of developing a urinary tract infection (UTI)?

Accepted Answer

Young women as well as persons with diabetes are at high risk of UTIs. Neither postsurgical recovery nor renal failure is necessarily a direct risk for UTI development, and high urine output would prevent decrease rather than increase in UTI risk.

Question 10

A 24-year-old college student has presented to the campus medical clinic with complaints of frequent, burning urination and has, subsequent to urinalysis, been diagnosed with an acute lower urinary tract infection (UTI) caused by E. coli. What teaching will the clinician most likely provide to the student?

Accepted Answer

Microbial resistance to TMP-SMX antibiotics is now common in the United States; however, other specific antibiotic options do exist. Cranberry and blueberry juice are more appropriate as preventative rather than curative measures (reduces bacterial adherence to the epithelial lining of the urinary tract), and the majority of uncomplicated UTIs in young women are not the result of urinary obstructions.

Question 11

Because the associated nephropathy is an important cause of end-stage renal failure in children and adolescents, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for

Accepted Answer

Urethrovesical reflux occurs when urine from the urethra moves into the bladder. Vesicoureteral reflux occurs when urine moves from the bladder into the ureter. Vesicoureteral reflux is the most commonly associated abnormality in UTIs. Reflux nephropathy is an important cause of end-stage renal disease in children and adolescents; children with a relatively uncomplicated first UTI may turn out to have significant reflux. Therefore, even a single documented UTI in a child requires careful diagnosis. Functional obstructions include neurogenic bladder, infrequent voiding, detrusor (bladder) muscle instability, and constipation.

Question 12

A female client with suspected glomerular disease has been referred to a nephrologist. The nurse knows that which of the following clinical manifestations may be present with the diagnosis of acute nephritic syndrome? Select all that apply.

Accepted Answer

In its most dramatic form, the acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished GFR, oliguria, and signs of impaired renal function. Inflammatory processes damage the capillary wall. This damage to the capillary wall allows RBCs to escape into the urine and produce a decrease in GFR. Extracellular fluid accumulation, hypertension, and edema develop because of the decreased GFR. Flank pain is usually associated with kidney stones.Oliguria occurs rather than excess urine output.

Question 13

A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?

Accepted Answer

Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A F1F1F1S1?F1F1F10-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens. Other organisms can also cause this infection.

Question 14

A 9-year-old boy has been diagnosed with the nephrotic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options.

Accepted Answer

The pathophysiology of the nephrotic syndrome involves damaged glomeruli becoming increasingly permeable to protein, allowing more protein into the glomerular filtrate.Massive proteinuria results, leading to hypoalbuminemia. Generalized edema, which is the hallmark of nephrotic syndrome, results from the loss of colloidal osmotic pressure of the blood with subsequent accumulation of fluid in the interstitial tissues.

Question 15

A 25-year-old Asian American man arrives in the emergency room in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused of his hematuria and how should it be treated?

Accepted Answer

Immunoglobulin A (IgA) nephropathy (Buerger disease) is a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits. It can occur at any age, but most commonly occurs with clinical onset in the second and third decades of life. It is more common in males than in females and is the most common cause of glomerular nephritis in Asians. There is no satisfactory treatment for IgA nephropathy. Goodpasture syndrome is a form of glomerulonephritis; treatment includes plasmapheresis to remove circulating anti-GBM antibodies and immunosuppressive therapy to inhibit antibody production. Membranous glomerulonephritis is the most common cause of primary nephrosis in adults, most commonly those in their sixth or seventh decade. It is treated with corticosteroids. In nodular glomerulosclerosis, also known as Kimmelstiel-Wilson syndrome, there is nodular deposition of hyaline in the mesangial portion of the glomerulus. As the sclerotic process progresses in the diffuse and nodular forms of glomerulosclerosis in many cases, early changes in glomerular function can be reversed by careful control of blood glucose levels. Control of high blood pressure and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes.

Question 16

A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be?

Accepted Answer

Heavy microscopic hematuria, proteinuria, and sensorineural deafness and eye disorders are characteristic of Alport syndrome. This symptomatology is less characteristic of systemic lupus erythematosus glomerulonephritis, Henoch-Schönlein purpura nephritis, or immunoglobulin A nephropathy.

Question 17

A nurse in an acute medical unit of a hospital has admitted a 62-year-old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?

Accepted Answer

Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea, and vomiting. Chronic rather than acute pyelonephritis is often caused by hypertension, while most cases are caused by ascending bacteria, not systemic infections. Scarring is more commonly a result of chronic pyelonephritis.

Question 18

A 34-year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle accident several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis stating, "I thought that taking too many drugs hurts your liver if anything, not your kidneys." What is the most appropriate response to the man's statement?

Accepted Answer

High flow and pressure combined with the metabolic transformative of drugs make the kidneys vulnerable to drug toxicity. They do not play a backup role to the liver in the metabolism of drugs, and while structural and functional damage may occur with drug overuse, infection is a less likely consequence. The elderly are particularly vulnerable to drug-related nephritis and nephropathies, but it would be incorrect to conclude that younger people are thus immune.

Question 19

A frantic mother brings her young child into the emergency department. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s)

Accepted Answer

Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. Stage IV means the tumors have undergone hematogenous metastasis, most commonly involving the lung. Treatment involves surgery, chemotherapy, and sometimes radiation therapy. Long-term survival rates are good (90%) for stages I to III.

Question 20

During a family picnic, a relative of a nurse asks what he should do if there is blood in his urine and some pain in his lower abdomen. The best advice the nurse could give this family member would be for him to

Accepted Answer

There are many causes of blood in the urine (infection, kidney stones, cancer, etc.). Kidney cancer can be a silent disorder with symptoms occurring late into the disease process. Any blood in the urine should be referred to the physician for further testing (ultrasound, CT scan, MRI, etc.).

Quiz 39: Alterations in Nutritional Status