A nurse is caring for a client who reports to the clinic for laboratory tests. The client has an acute kidney injury caused by acute tubular necrosis and 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?

The glomerular filtration rate decreases because there is injury to the renal tubular cells.

The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down.

The glomerular filtration rate decreases because in?ammatory cells invade the already damaged kidneys.

The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys.

Answer and Explanation

The Correct Answer is A

Choice A reason: Acute tubular necrosis (ATN) is a condition where there is damage to the renal tubular cells, which can lead to a decrease in GFR. This is because the tubular cells are responsible for reabsorbing substances from the filtrate back into the blood. When these cells are injured, they cannot function properly, leading to a buildup of waste products and a decrease in GFR.

Choice B reason: While obstruction can lead to a decrease in GFR, it is not the primary cause in the context of acute tubular necrosis. Obstruction typically occurs in postrenal causes of acute kidney injury.

Choice C reason: In?ammatory cells do invade damaged kidneys, but this is more characteristic of conditions such as acute interstitial nephritis rather than ATN. In ATN, the primary issue is the injury to the tubular cells themselves.

Choice D reason: A reduction of blood flow to the kidneys, or prerenal azotemia, can indeed lead to a decrease in GFR. However, in the context of ATN, the primary issue is not the blood flow but the damage to the renal tubules.

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Correct Answer is C

Explanation

Choice A reason: Decreasing the IV fluid infusion rate and limiting oral fluid intake may not be appropriate without further assessment, as the client's BUN level is elevated, which could indicate dehydration or renal impairment. The normal range for BUN is typically 7-20 mg/dL.

Choice B reason: Collecting a urine specimen for culture and sensitivity may be necessary if there is a suspicion of infection, but there is no indication of infection based solely on the provided lab values.

Choice C reason: Evaluating urine for amount and specific gravity can help assess the client's hydration status and kidney function, which is pertinent given the elevated BUN level and ongoing nausea and vomiting.

Choice D reason: Continuing routine care may not be appropriate because the BUN level is above the normal range, indicating that further assessment and intervention may be necessary.

A. Elevated creatinine level B. Urinary retention C. Flank pain D. Bleeding tendencies

Correct Answer is D

Explanation

Choice A reason: An elevated creatinine level indicates reduced kidney function, which is often the reason a kidney biopsy is being performed in the first place. It is not a contraindication for the procedure.

Choice B reason: Urinary retention does not directly impact the ability to perform a kidney biopsy, as the procedure involves the kidneys and not the lower urinary tract where urine is stored.

Choice C reason: Flank pain is a common symptom in patients with kidney issues and is not a contraindication for a kidney biopsy. The procedure may help diagnose the cause of the ?ank pain.

Choice D reason: Bleeding tendencies are a significant contraindication for a kidney biopsy. Patients with a history of bleeding disorders or those on anticoagulant therapy are at increased risk of bleeding complications from the procedure.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a male client who reports nausea and vomiting and is receiving IV fluid therapy. His blood urea nitrogen (BUN) is 32 mg/dL, creatinine is 1.1 mg/dL, and hematocrit is 50%. Which of the following nursing interventions is appropriate?

Correct Answer is C

Explanation

A nurse is preparing a client for a kidney biopsy. Which of the following client conditions should the nurse identify as a contraindication for this diagnostic test?

Correct Answer is D

Explanation

A nurse is providing discharge teaching to a client who will be performing continuous ambulatory peritoneal dialysis (CAPD) at home. Which of the following statements from the client indicates an understanding of this type of dialysis management? (Select all that apply)

A nurse manager at a skilled nursing facility has noticed an increase in urinary tract infections (UTIs) by 12% in the past year. In an e?ort to decrease this rate, which of the following should the nurse manager teach the nursing sta?? (Select all that apply.)

A nurse is caring for a client in the clinic who has a distended bladder with discomfort over the area and a sense of fullness. Which of the following tests should the nurse expect the health care provider to order to determine if the client has urinary retention? (Select all that apply.)

A nurse is providing teaching to a client about completing a creatinine clearance test. Which of the following instructions should the nurse include in the teaching?

A nurse is caring for a client who is receiving peritoneal dialysis. The nurse should monitor the client for which of the following manifestations of peritonitis?

A nurse is caring for a group of clients diagnosed with polycystic kidney disease (PKD). While teaching about ways to slow the progression to end-stage renal disease (ESRD), which of the following topics would be most important for the nurse to include?