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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Massaging the legs frequently is not recommended for peripheral venous disease as it can dislodge clots that may be present, leading to serious complications.
Choice B rationale
Keeping the legs in a dependent position can worsen the symptoms of peripheral venous disease by increasing venous pressure and swelling.
Choice C rationale
Inspecting the legs daily for changes is a key part of self-management for peripheral venous disease. It helps in early detection of potential complications.
Choice D rationale
Decreasing activity is not advised unless specified by a healthcare provider. Regular activity can actually help improve circulation and manage symptoms.
Correct Answer is D
Explanation
Choice A rationale
Jaundice of the sclera is indicative of hyperbilirubinemia, which can occur in various liver diseases but is not specifically associated with Grey Turner's sign or pancreatitis.
Choice B rationale
Bluish discoloration of the periumbilical area, known as Cullen's sign, is another indicator of severe pancreatitis but is distinct from Grey Turner's sign, which specifically refers to the flank area.
Choice C rationale
Left abdominal pain that occurs with movement may be a symptom experienced by patients with pancreatitis, but it is not referred to as Grey Turner's sign, which is a physical finding rather than a symptom.
Choice D rationale
Grey Turner's sign is characterized by bluish discoloration of the flank area. It is a sign of retroperitoneal hemorrhage, which can occur in severe cases of pancreatitis due to the spread of pancreatic enzymes to surrounding tissues, leading to localized bleeding.
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