A nurse is caring for a client who has an acute kidney injury caused by acute tubular necrosis. The client asks why their glomerular filtration rate (GFR) keeps decreasing. Which of the following pathophysiological changes occurring in the kidney should the nurse explain as the cause of the decrease?

Inflammatory cells invade the already damaged kidneys.

There is a reduction of blood flow to the kidneys.

There is injury to the renal tubular cells.

There is obstruction leading to the filtration system backing up and eventually shutting the kidneys down.

Answer and Explanation

The Correct Answer is C

Choice A rationale
While inflammation can affect the kidneys, the presence of inflammatory cells alone does not typically cause a decrease in GFR. Inflammatory cells invading the kidneys is more associated with conditions like glomerulonephritis rather than acute tubular necrosis.

Choice B rationale
A reduction in blood flow to the kidneys, known as prerenal azotemia, can indeed lead to a decreased GFR. However, in the context of acute tubular necrosis, the primary issue is damage to the renal tubules rather than blood flow.

Choice C rationale
Acute tubular necrosis is characterized by damage to the renal tubular cells, which can lead to a decrease in GFR. This damage impairs the kidney's ability to filter waste products from the blood, resulting in a lower GFR.

Choice D rationale
Obstruction of the urinary tract can lead to postrenal azotemia, which may decrease GFR if severe enough. However, this is not the typical pathophysiological change seen in acute tubular necrosis, which primarily involves tubular cell injury.

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Correct Answer is C

Explanation

Choice A rationale
A high calcium diet and hypercalcemia are not directly associated with pyelonephritis. While dietary habits and blood calcium levels can impact overall health, they do not typically contribute to the development of pyelonephritis.

Choice B rationale
Long-term use of ibuprofen can lead to kidney damage, which may increase the risk of pyelonephritis, especially if there is pre-existing kidney impairment. However, it is not as directly related to pyelonephritis as a history of UTIs.

Choice C rationale
A history of UTIs is relevant to pyelonephritis, as the infection can ascend from the lower urinary tract to the kidneys. Recurrent UTIs are a risk factor for pyelonephritis, making this the most likely report from the client.

Choice D rationale
Genetic diseases can have various impacts on health, but there is no common genetic disease that directly causes pyelonephritis. This choice is less likely to be relevant to the client's current condition.

A. Obtain orders from the health care provider to discontinue catheters as soon as possible. B. Remind clients to urinate right away when they have an urge and to completely empty their bladder. C. Promote perineal care that includes wiping the perineum from front to back. D. Encourage continuing prescribed antibiotics even if the client's symptoms have subsided. E. Encourage adequate fluid intake every day if appropriate.

Correct Answer is ["A","C","D","E"]

Explanation

Choice A rationale
Removing catheters as soon as they are no longer necessary can significantly reduce the risk of catheter-associated urinary tract infections (CAUTIs)¹.

Choice B rationale

While it is important for clients to urinate when they feel the urge, this practice alone is not specifically targeted at reducing the rate of urinary tract infections.

Choice C rationale

Teaching proper perineal care, including wiping from front to back, can help prevent the spread of bacteria to the urethra and reduce the risk of UTIs¹.

Choice D rationale

Continuing prescribed antibiotics until the full course is completed, even if symptoms improve, is crucial to ensure all bacteria are eliminated and to prevent antibiotic resistance³.

Choice E rationale

Adequate fluid intake helps flush bacteria from the urinary tract, which can decrease the incidence of UTIs¹.

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Naxlex Comprehensive Predictor Exams

A nurse is gathering medical history from a client admitted for pyelonephritis. Which of the following should the nurse expect the client to report when asked about their medical history?

Correct Answer is C

Explanation

In an effort to decrease the rate of urinary tract infections, which of the following should the nurse manager teach the nursing staff? (Select all that apply)

Correct Answer is ["A","C","D","E"]

Explanation

After assessing a patient with ulcerative colitis (UC), the nurse concludes that the patient has moderate disease. Which patient symptoms support the nurse's conclusion? (Select all that apply.)

A nurse is educating the public at a health fair about colorectal cancer. Which of the following risk factors increase the risk of developing colorectal cancer? (Select all that apply.)

A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?

A nurse is caring for a patient diagnosed with peptic ulcer disease. Which complication would result in gastric contents spilling into the patient's peritoneal cavity?

Which finding in the patient's history increases the risk for acute pancreatitis?

A nurse is teaching a client who has hepatitis A about preventing the transmission of the virus. Which of the following strategies should the nurse include in the teaching?

A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (Select all that apply.)