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.
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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Related Questions
Correct Answer is B
Explanation
Choice A reason: The erythrocyte sedimentation rate (ESR) is not directly affected by epoetin alfa therapy, which is used to treat anemia.
Choice B reason: Epoetin alfa stimulates erythropoiesis, leading to an increase in red blood cell production, which would be reflected in an increased hematocrit level.
Choice C reason: The platelet count is not directly affected by epoetin alfa therapy.
Choice D reason: The leukocyte count is not directly affected by epoetin alfa therapy.
Correct Answer is ["A","B","D","E","F"]
Explanation
Choice A reason: A WBC count can help determine the presence of infection.
Choice B reason: Blood cultures may be ordered if there is a concern for a systemic infection or sepsis.
Choice C reason: Foley catheter placement is not typically indicated for UTI and can increase the risk of infection.
Choice D reason: A broad-spectrum antibiotic may be prescribed to treat the suspected UTI until specific causative bacteria are identified.
Choice E reason: IV fluids may be administered to ensure hydration, especially if the client is unable to maintain adequate oral intake due to nausea or vomiting.
Choice F reason: A clean-catch urinalysis and urine culture are essential to identify the specific bacteria causing the UTI and to determine the appropriate antibiotic therapy.
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