chapter 33: disorders of renal function

Question 1

a nonsurgical treatment that uses soundwaves, laser, or dry shock wave energy to break apart the stones

Answer 1

extracorporeal shock wave lithotripsy (ESWL)

Question 2

the initiating even in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to

Answer 2

plasma proteins

Question 3

most common uncomplicated UTIs are caused by _______ that enter through the urethra

Answer 3

E. coli

Question 4

substances present in glomerular filtrate

Answer 4

• potassium
• sodium
• water

Question 6

the nurse caring for an older adult notes a marked decrease in mental acuity over a 24h period. what assessment indicates the most likely cause of this change

Answer 6

cloudy urine w/ a strong odor

Question 7

what condition/disorder would a nurse see as most likely to cause the most serious long-term issues

Answer 7

polycystic kidney disease

may be associated w/ aneurysm, subarachnoid hemorrhage

Question 8

surgical stone removal is indicated for which instance

Answer 8

obstruction of urine flow

open stone surgery may be required to remove large calculi or those that are resistant to other forms of removal; kidney stones are a major cause of upper UT obstruction

Question 9

characterized by cystic dilation of the cortical and medullary collecting tubules; rare; usually presents as severe renal dysfunction during infancy

Answer 9

autosomal recessive polycystic kidney disease

Question 10

what is the usual cause of acute pyelonephritis

Answer 10

infection

Question 11

magnesium renal stones are associated with which medical problem?

Answer 11

infection

also called struvite stones, form only in alkaline urine and in the presence of bacteria that possess an enzyme called urease, which splits the urea in the urine into ammonia and carbon dioxide.

Question 12

Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client

Answer 12

will not undergo an acute kidney injury by decreasing renal blood flow

Question 13

The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse’s best response?

Answer 13

corticosteroids

Question 14

Which laboratory findings would the nurse anticipate in a client diagnosed with nephritic syndrome?

Answer 14

Elevated urine protein level (>3.5 g/day) and hypoalbuminemia

The nephritic syndrome is due to glomerular disease that is usually of acute onset and is accompanied by grossly visible hematuria, mild to moderate proteinuria, and hypertension.

Question 15

If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?

Answer 15

lower extremities

Question 16

what is the most common cause of acute postinfectious glomerulonephritis

Answer 16

a streptococcal infection 7-12 days prior to onset

Question 17

what commonly causes chronic pyelonephritis, resulting in renal scarring and atrophy

Answer 17

intrarenal reflux

Reflux, the most common cause of chronic pyelonephritis, results from superimposition of infection on congenital vesicoureteral reflux or intrarenal reflux. Reflux may be unilateral with involvement of a single kidney or bilateral, leading to scarring and atrophy of both kidneys with the eventual development of chronic renal insufficiency. Acute pyelonephritis represents a patchy, interstitial, infectious bacterial inflammatory process, with abscess formation and tubular necrosis.

Question 18

which client clinical manifestation clearly suggests a need for diagnostic testing to rule out renal cell carcinoma

Answer 18

hematuria

Question 18

the nurse is reviewing the lab results of a client w/ suspected nephrotic syndrome. the nurse anticipates the results to include

Answer 18

protein in the urine

Question 19

what acconts for the most common cancer of the kidney

Answer 19

renal cell carcinoma

Question 20

unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation

Answer 20

increased blood pressure

Question 21

inflammation of that involves all glomeruli and all parts of the glomeruli

Answer 21

diffuse glomerulonephritis

Question 22

inflammation in which only some of the glomeruli are affected

Answer 22

focal glomerulonephritis

Question 23

inflammation in which only a certain sent of each glomeruli is affected

Answer 23

segmental glomerulonephritis

Question 24

inflammation that affects only the mesangial cells of the glomerulus

Answer 24

mesangial glomerulonephritis

Question 25

A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it’s mapped to chromosome 11. What disease will the client most likely develop?

Answer 25

Wilms tumor

Wilms tumor gene, WT1, which is located on chromosome 11, encodes a transcription factor that is critical for normal kidney development. Roughly 20% of all Wilms tumors carry WT1 mutations

Question 26

Several clients in clinic today are reporting urinary signs/symptoms. Which reported manifestation(s) leads the health care provider to suspect acute pyelonephritis?

Answer 26

• flank pain in the back
• abrupt onset of fever and chills
• urinary urgency and frequency

Question 27

The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?

Answer 27

increased blood pressure

Question 28

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?

Answer 28

reduced production of erythropoietin (EPO)

As ADPKD progresses, the nephrons reduce the production of erythropoietin (EPO). EPO is necessary for red blood cell production by bone marrow, so EPO deficiency causes anemia.

Question 29

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?

Answer 29

large asymptomatic abdominal mass and hypertension

Question 29

What are appropriate interventions in the care of a client diagnosed with renal calculi?

Answer 29

• keeping track of intake and output
• addressing the client’s pain
• straining the client’s urine