Unit1: Ch 33- Disorders of Renal Function (Porth 5th Ed)

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.
A) One of the infant’s kidneys may have failed to develop normally.
B) The kidneys may be misshapen and have cysts present.
C) The upper or lower poles of the two kidneys may be fused.
D) Renal cell carcinoma may be present.
E) Urine-filled dilation of renal pelvis associated with atrophy of the kidney may be present.

Answer 1

Ans: A, B, C
Feedback:
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?
A) UTIs coupled with an impaired immune response have caused her ADPKD.
B) She has inherited a tendency for epithelial cells in her tubules to proliferate
inappropriately.
C) Severe hypertension and portal hypertension are likely precursors.
D) She has inherited undersized kidneys that are prone to calculi formation.

Answer 2

Ans: B
Feedback:
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
A) serum creatinine levels.
B) blood urea nitrogen (BUN) level.
C) urine albumin excretion (UAE).
D) urine specific gravity.

Answer 3

Ans: C
Feedback:
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.
A) A 43-year-old male with an acid–base imbalance secondary to malnutrition
B) A 29-year-old female, pregnant for the first time
C) A 69-year-old female with anemia secondary to insufficient erythropoietin
production
D) A 70-year-old male with benign prostatic hyperplasia (BPH)
E) A 58-year-old male with renal calculi
F) A 28-year-old male with a neurogenic bladder secondary to spinal cord injury

Answer 4

Ans: B, D, E, F
Feedback:
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?
A) Hydroureter and pain
B) Development of renal calculi and renal cysts
C) Unilateral hydronephrosis and pain
D) Development of glomerulonephritis or nephrotic syndrome

Answer 5

Ans: A
Feedback:
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?
A) “Your diet may have played a part in this, but in fact, genetics are likely primarily
to blame.”
B) “What you eat can influence your risk of stone formation, but many other factors
like hormones and your metabolism are involved.”
C) “You likely don’t need to change your diet, but now that you have stones in one
kidney, you’re at very high risk of growing them in the other kidney.”
D) “Your diet might be normally healthy, but high intake of normally beneficial
minerals like calcium and magnesium can lead to stones.”

Answer 6

Ans: B
Feedback:
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?
A) Right upper quadrant pain that worsens with deep breaths and palpation
B) Excruciating pain in the flank and upper quadrant of the abdomen that
radiates to the bladder area
C) Pain described as “fire poking in their side,” pulsating with every heart beat but decreases when in fetal position
D) Perineal pain that increases when urinating and then lessens until the time to urinate again

Answer 7

Ans: B
Feedback:
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.
A) “You may need to cut out cocoa, chocolate, and some nuts from your diet.”
B) “It’s important that you avoid high-calcium foods like milk, cheese, and yogurt.”
C) “We will come up with a plan to safely limit your fluid intake over the next few weeks.”
D) “Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones.”
E) “Most likely your stones can be dissolved by medications over the next several days.”

Answer 8

Ans: A, D
Feedback:
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)?
A) A 60-year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft
B) A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension
C) A 38-year-old man with high urine output due to antidiuretic hormone
insufficiency
D) A 30-year-old woman with poorly controlled diabetes mellitus

Answer 9

Ans: D
Feedback:
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?
A) “This should likely resolve itself if you drink a lot of water and especially
cranberry or blueberry juice.”
B) “Unfortunately, the bacteria causing your infection is no longer responsive to antibiotics, but there are alternative treatments that we can use.”
C) “Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe.”
D) “This likely shows that you have some sort of obstruction in your urinary system, so when that is treated your UTI will likely resolve as well.”

Answer 10

Ans: C
Feedback:
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 evluated for
A) urethrovesical reflux.
B) vesicoureteral reflux.
C) neurogenic bladder.
D) detrusor muscle instability.

Answer 11

Ans: B
Feedback:
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.
A) Sudden onset of hematuria
B) Proteinuria
C) Flank pain
D) Excess urine output
E) Edema

Answer 12

Ans: A, B, E
Feedback:
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?
A) “Do you have a history of heart failure?”
B) “Have you recently had kidney stones?”
C) “Have you ever been diagnosed with diabetes?”
D) “Have you had any type of infection within the last 2 weeks?”

Answer 13

Ans: D
Feedback:
Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group A -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.
A) Hypoalbuminemia
B) Increased glomerular membrane permeability
C) Decreased colloidal osmotic pressure
D) Proteins escape from the plasma to the glomerular filtrate
E) Accumulation of fluid in the interstitial tissue (edema)

Answer 14

Ans: B, D, A, C, E
Feedback:
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?
A) Goodpasture syndrome and will be treated with plasmapheresis and
immunosuppressive therapy
B) Membranous glomerulonephritis and should be treated with corticosteroids
C) Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease
D) Kimmelstiel-Wilson syndrome and should be treated with medication to control high blood pressure

Answer 15

Ans: C
Feedback:
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?
A) Alport syndrome
B) Systemic lupus erythematosus glomerulonephritis
C) Henoch-Schönlein purpura nephritis
D) Immunoglobulin A nephropathy

Answer 16

Ans: A
Feedback:
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?
A) Most cases of acute pyelonephritis are attributable to poorly controlled
hypertension.
B) Flank pain, dysuria, and nausea and vomiting are likely assessment findings.
C) The infection in the kidney is most likely a manifestation of a systemic infection.
D) Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis.

Answer 17

Ans: B
Feedback:
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?
A) “Your liver does perform most of the detoxification in your body, but your
kidneys can perform this role if the liver is unable to.”
B) “High drug intake can cause your kidneys to be very vulnerable to infections, which is likely what happened in your case.”
C) “Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs.”
D) “It is very rare for someone as young as yourself to have kidney damage like this; usually only older people are vulnerable to kidney damage from drugs.”

Answer 18

Ans: C
Feedback:
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)
A) “has cancer in his stomach.”
B) “has cancer in the kidney that has spread most likely to his lungs.”
C) “will need to undergo surgery to remove both kidneys and then go on dialysis.”
D) “tumor can be easily treated with chemotherapy. We will start this soon.”

Answer 19

Ans: B
Feedback:
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
A) go to the emergency room right away.
B) get an appointment with his family doctor.
C) wait and see if it goes away without treatment.
D) increase his intake of cranberry juice and other fluids.

Answer 20

Ans: B
Feedback:
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.).