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Glomerulonephritis
Renal Failure
Pharmacology
Glomerulonephritis
Renal Failure
100
A patient with a diagnosis of glomerulonephritis with fluid retention might have which of the following laboratory values? A. Proteinuria B. Low specific gravity C. Low serum creatinine D. High hemoglobin
ANSWER: A RATIONALE: Patients with glomerulonephritis will have a urinalysis that reveals proteinuria and elevated specific gravity. Blood tests indicate elevated plasma BUN and serum creatinine; hemoglobin and hematocrit may be low related to fluid retention.
100
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find? A. Decreased blood urea nitrogen (BUN) B. Decreased potassium C. Increased serum albumin D. Increased serum creatinine
ANSWER: D RATIONALE: In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
100
Polystyrene sulfonate (Kayexalate) is used in renal failure to: A. Correct acidosis B. Reduce serum phosphate levels C. Exchange potassium for sodium D. Prevent constipations from sorbitol use
ANSWER: C RATIONALE: In renal failure, patients become hyperkalemic because they can’t excrete potassium in the urine. Polystyrene sulfonate acts to excrete potassium by pulling potassium into the bowels and exchanging it for sodium.
100
The client has been diagnosed with chronic glomerulonephritis. The nurse should teach the client that the disease may progress to: A.Systemic lupus B. Erythematosus C. Diabetes mellitus D. End stage renal disease
ANSWER: D RATIONALE: Chronic glomerulonephritis results from lupus nephritis, diabetic nephropathy and rapidly progressive glomerulonephritis. Glomeruli are destroyed and the signs of renal failure develop.
100
A patient with diabetes has had many renal calculi over the past 20 years and now had chronic renal failure. Which substance must be reduced in this patient’s diet? A. Carbohydrates B. Fats C. Protein D. Vitamin C
ANSWER: C RATIONALE: Because of damage to the nephrons, the kidney can’t excrete all the metabolic wastes of protein, so this patient’s protein intake must be restricted. A higher intake of carbs, fats, and vitamin supplements is needed to ensure the growth and maintenance of the patient’s tissues.
200
Which of the following conditions most commonly causes acute glomerulonephritis? A. A congenital condition leading to renal dysfunction. B. Prior infection with group A Streptococcus within the past 10-14 days. C. Viral infection of the glomeruli. D. Nephrotic syndrome.
ANSWER: B RATIONALE: Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.
200
A client with chronic renal failure has had an arteriovenous fistula created for hemodialysis. The nurse should assess this client for: A. Homan’s sign B. Periorbital edema C. A renal bruit D. A bruit and a thrill
ANSWER: D RATIONALE: The client needs to be assessed for a functional arteriovenous fistula by palpating a thrill and auscultating a bruit. Clients may have edema which is usually peripheral. A renal bruit indicates turbulent blood flow in the renal artery. A positive Homan’s sign may indicate a deep vein thrombosis.
200
The client with chronic renal failure has a serum potassium of 6.6 mEq/L. The nurse should anticipate an order for: A. Furosemide (Lasix) B. Aluminum hydroxide (Amphojel) C. Propranolol (Inderal) D. Sodium polystyrene sulfonate (Kayexalate)
ANSWER: D RATIONALE: The client with renal failure with a potassium level above 6.5 mEq/L is treated with sodium polystyrene sulfonate (Kayexalate SPS suspension). Sodium polystyrene exchanges sodium ions for potassium in the intestines. Fureosimide (Lasix) removes sodium and excess fluid. Aluminum hydroxide (Amphojel) is used to control hyperphosphatemia. Propranolol (Inderal) may control hypertension.
200
An 18-year-old student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student’s health history? A. Renal calculi B. Renal trauma C. Recent sore throat D. Family history of acute glomerulonephritis
ANSWER: C RATIONALE: The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body.
200
The nurse is caring for a client with acute renal failure. When providing the dietary instruction, the nurse would evaluate that the client has understood the instructions when the client states: A. “I would avoid cereal with bananas and orange juice.” B. “I would avoid coffee, bacon, eggs, and rye toast.” C. "I would avoid meatloaf, green beans, and country biscuits.” D. “I would avoid tilapia, baked macaroni, and cheese with stewed tomatoes.”
ANSWER: A RATIONALE: A client with renal failure should avoid foods high in potassium and sodium. Foods high in potassium include non salt seasoning mixes, potatoes, bananas, and orange juice.
300
A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? (Select all that apply.) A. Urine specific gravity of 1.040 B. Urine output of 350 mL in 24 hours C. Brown (“tea-colored”) urine D. Generalized edema
ANSWER: A, B, and C RATIONALE: Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark "tea colored” urine caused by large amounts of red blood cells. There is periorbital edema, but generalized edema is seen in nephrotic syndrome, not acute glomerulonephritis.
300
A client newly diagnosed with chronic renal failure has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse monitors the client during dialysis for: A. Hypertension, tachycardia, and fever B. Hypotension, bradycardia, and hypothermia C. Restlessness, irritability, and generalized weakness D. Headache, deteriorating level of consciousness, and twitching
ANSWER: D RATIONALE: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by a rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. It most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
300
A client with chronic renal failure is receiving epoetin alfa (Epogen, Procrit). Which laboratory result would indicate a therapetutic effect of the medication? A. Hematocrit of 32% B. Platelet count of 400,000 cells/mm3 C. Blood urea nitrogen level of 15 mg/dL D. WBC 6000 cells/mm3
ANSWER: A RATIONALE: Epoetin alfa is used to reverse anemia associated with chronic renal failure. Therapeutic effect is seen when the hematocrit is between 30% and 33%. Options 2, 3, and 4 are not associated with the action of this medication.
300
A client with glomerulonephritis is at risk of developing acute renal failure. The nurse monitors the client for which sign of this complication? A. Bradycardia B. Hypertension C. Decreased cardiac output D. Decrease central venous pressure
ANSWER: B RATIONALE: Acute renal failure caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of acute renal failure is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid overload. Acute renal failure from prerenal causes is characterized by decreased blood pressure or a recent history of the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not part of the clinical picture for renal failure.
300
When caring for a client with acute renal failure, the nurse would plan which of the following treatment goals for the client? A. Prevent infection by administering antibiotics. B. Compensate for renal impairment by restoring fluid balance. C. Increase fluids to prevent nephroliathasis. D. Maintain adequate nutrition by encouraging a high protein and calorie diet.
ANSWER: B RATIONALE: The treatment goals for acute include: identifying and correcting underlying cause, preventing kidney damage, restoring urine output and kidney function and compensating for renal impairment.
400
A nurse is presenting information to a client who has a new diagnosis of chronic glomerulonephritis. Which of the following nursing statements is appropriate? A. A high sodium diet is recommended B. The destruction of the glomeruli occurs rapidly C. The cause of the disease is not known D. To compensate, the number of functioning nephrons is increased
ANSWER: C RATIONALE: With chronic glomerulonephritis, the kidney atrophies, and tissue is not available for biopsy and Dx, making it difficult to determine the cause. With chronic glomerulonephritis a low sodium diet is recommended to slow fluid retention. Destruction of glomeruli is progressive over a long period of time. The number of functioning nephrons decrease over time, leading to end stage kidney failure.
400
A client with chronic renal failure has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. The nurse interprets that these data are compatible with: A. Advancing uremia B. Phosphate overdose C. Folic Acid deficiency D. Aluminum intoxication
ANSWER: D RATIONALE: Aluminum intoxication may occur when there is accumulation of aluminum, an ingredient in many phosphate binding antacids. It results in mental cloudiness, dementia, and point pain form infiltration of the bone with aluminum.
400
The client diagnosed with ARF is experiencing hyperkalemia. Which medication should the nurse prepare to administer to help decrease the potassium level? A. Erythropoietin B. Calcium gluconate C. Regular insulin D. Osmotic diuretic
ANSWER: C RATIONALE: Regular insulin, along with glucose, will drive potassium into the cells, thereby lowering serum potassium levels temporarily.Erythropoietin is a chemical catalyst produced by the kidneys to stimulate red blood cell production; it does not affect potassium level. Calcium gluconate helps protect the heart from the effects of high potassium levels. A loop diuretic, not an osmotic diuretic, may be ordered to help decrease the potassium level.
400
The elderly client is diagnosed with chronic glomerulonephritis. Which laboratory value indicates to the nurse the condition has become worse? A. The BUN is 15 mg/dL B. The creatinine level is 1.2 mg/dL C. The glomerular filtration rate is 40 mL/min D. The 24-hour creatinine clearance is 100 mL/min
ANSWER: C RATIONALE: Normal blood urea nitrogen levels are 7 to 18 mg/dL or 8 to 20 mg/dL for clients older than age 60 years. Normal creatinine levels are 0.6 to 1.2 mg/dL. Glomerular filtration rate (GFR) is approximately 120 mL/min. If the GFR is decreased to 40 mL/min, the kidneys are functioning at about one-third filtration capacity. Normal creatinine clearance is 85 to 125 mL/min for males and 75 to115 mL/min for females.
400
In the client experiencing acute renal failure, the nurse should evaluate which laboratory diagnostic tests to assess renal function? (Select all that apply.) A. Blood urea nitrogen (BUN) B. Creatinine C. Electrolytes D. Complete blood count
ANSWER: A and B RATIONALE: Serum blood urea nitrogen, creatinine, electrolytes and complete blood count. Blood urea nitrogen and creatinine evaluate renal function. Electrolytes will provide information on hyponatremia and hyperkalemia. Complete blood count will indicate the degree of anemia in a renal client.
500
A nurse is providing teaching on the manifestation of complications to a client who has acute glomerulonephritis. Which of the following complications should the client report to the provider? A. Dry cough B. Pitting edema C. Weight gain of 2 pounds in 1 week D. Temperature of 36.8 C (98.4 F)
ANSWER: B RATIONALE: Pitting edema is an indication of fluid overload, a manifestation of a complication of acute glomerulonephritis. A dry cough does not indicate fluid overload. Fluid overload manifests with a wet cough and crackles as a complication of acute glomerulonephritis. A weight gain of 2 pounds in 1 week is not a complication. However, a weight gain of 5 pounds in 1 week is a sign of fluid overload, a complication of acute glomerulonephritis. A temperature of 36.8 C (98.4F) is not a complication of acute glomerulonephritis. However, a low grade fever may indicate an infection.
500
Your patient with chronic renal failure reports pruritis. Which instruction should you include in this patient’s teaching plan? A. Rub the skin vigorously with a towel B. Take frequent baths C. Apply alcohol-based emollients to the skin D. Keep fingernails short and clean
ANSWER: D RATIONALE: Calcium-phosphate deposits in the skin may cause pruritis. Scratching leads to excoriation and breaks in the skin that increase the patient’s risk of infection. Keeping fingernails short and clean helps reduce the risk of infection.
500
The client in end-stage renal disease is taking calcitriol, a Vitamin D analogue. Which client assessment date would warrant an intervention by the nurse concerning this medication? A. Increased visual acuity B. Hematuria C. Increased bone density D. Stratorrhea
ANSWER: B RATIONALE: Hematuria is an adverse effect of the calcitriol, and the nurse should notify the HCP to ask about discontinuing the mediation. Vitamin D does increase visual acuity and not affect the stool. Increased bone density indication the medication is effective.
500
Clinical manifestations of acute glomerulonephritis include which of the following? A. Chills and flank pain B. Oliguria and generalized edema C. Hematuria and proteinuria D. Dysuria and hypotension
ANSWER: C RATIONALE: Hematuria and proteinuria indicate acute glomerulonephritis. These findings result from increased permeability of the glomerular membrane due to the antigen-antibody reaction. Generalized edema is seen most often in nephrosis.
500
After a renal biopsy, the client complained of pain at the biopsy site, which radiates to the front of the abdomen. Based on this complaint, the nurse further monitors the client for: A. Bleeding B. Infection C. Renal colic D. Normal expected pain
ANSWER: A RATIONALE: If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected. Hypotension, a decreasing HCT, and gross microscopic hematuria would also indicate bleeding.