Patho Test 4- Ch.41

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.

One of the infant's kidneys may have failed to develop normally.

The kidneys may be misshapen and have cysts present.

The upper or lower poles of the two kidneys may be fused.

Renal cell carcinoma may be present.

Urine-filled dilation of renal pelvis associated with atrophy of the kidney may be present.

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?

UTIs coupled with an impaired immune response have caused her ADPKD.

She has inherited a tendency for epithelial cells in her tubules to proliferate inappropriately.

Severe hypertension and portal hypertension are likely precursors.

She has inherited undersized kidneys that are prone to calculi formation.

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

Serum creatinine levels.

Blood urea nitrogen (BUN) level

Urine albumin excretion (UAE).

Urine specific gravity.

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 43-year-old male with an acid–base imbalance secondary to malnutrition

A 29-year-old female, pregnant for the first time

A 69-year-old female with anemia secondary to insufficient erythropoietin production

A 70-year-old male with benign prostatic hyperplasia (BPH)

A 58-year-old male with renal calculi

A 28-year-old male with a neurogenic bladder secondary to spinal cord injury

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?

Hydroureter and pain

Development of renal calculi and renal cysts

Unilateral hydronephrosis and pain

Development of glomerulonephritis or nephrotic syndrome

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?

�Your diet may have played a part in this, but in fact, genetics are likely primarily to blame.”

�What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved.”

�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.”

�Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones.”

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

Right upper quadrant pain that worsens with deep breaths and palpation

Excruciating pain in the flank and upper outer quadrant of the abdomen that radiates to the bladder area

Pain described as “fire poking in their side,” pulsating with every heart beat but decreases when in fetal position

Perineal pain that increases when urinating and then lessens until the time to urinate again

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.

�You may need to cut out cocoa, chocolate, and some nuts from your diet.”

It's important that you avoid high-calcium foods like milk, cheese, and yogurt.”

�We will come up with a plan to safely limit your fluid intake over the next few weeks.”

�Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger stones.”

�Most likely your stones can be dissolved by medications over the next several days.”

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

A 60-year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft

A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension

A 38-year-old man with high urine output due to antidiuretic hormone insufficiency

A 30-year-old woman with poorly controlled diabetes mellitus

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?

�This should likely resolve itself if you drink a lot of water and especially cranberry or blueberry juice.”

�Unfortunately, the bacteria causing your infection is no longer responsive to antibiotics, but there are alternative treatments that we can use.”

�Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe.”

�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.”

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

Urethrovesical reflux.

Vesicoureteral reflux.

Neurogenic bladder.

Detrusor muscle instability.

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

�Do you have a history of heart failure?”

�Have you recently had kidney stones?”

�Have you ever been diagnosed with diabetes?”

�Have you had any type of infection within the last 2 weeks?”

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)

BDACE

ABCDE

DACBE

EDBCE

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?

Goodpasture syndrome and will be treated with plasmapheresis and immunosuppressive therapy

Membranous glomerulonephritis and should be treated with corticosteroids

Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease

Kimmelstiel-Wilson syndrome and should be treated with medication to control high blood pressure

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?

Alport syndrome

Systemic lupus erythematosus glomerulonephritis

Henoch-Schönlein purpura nephritis

Immunoglobulin A nephropathy

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?

Most cases of acute pyelonephritis are attributable to poorly controlled hypertension.

Flank pain, dysuria, and nausea and vomiting are likely assessment findings.

The infection in the kidney is most likely a manifestation of a systemic infection.

Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis.

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?

�Your liver does perform most of the detoxification in your body, but your kidneys can perform this role if the liver is unable to.”

High drug intake can cause your kidneys to be very vulnerable to infections, which is likely what happened in your case.”

�Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs.”

�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.”

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)

�has cancer in his stomach.”

�has cancer in the kidney that has spread most likely to his lungs.”

�will need to undergo surgery to remove both kidneys and then go on dialysis.”

�tumor can be easily treated with chemotherapy. We will start this soon.”

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

Go to the emergency room right away.

Get an appointment with his family doctor.

Wait and see if it goes away without treatment.

Increase his intake of cranberry juice and other fluids.

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Patho Test 4- Ch.41

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