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 D

Explanation

Choice A reason: The nurse is not providing surgical site or wound care by documenting urination.

Choice B reason: Managing postoperative pain is not directly related to monitoring the client's ability to urinate.

Choice C reason: Assisting with early ambulation does not pertain to the urinary function directly.

Choice D reason: Monitoring urinary function is part of postoperative care, especially after removal of a Foley catheter, to ensure the client is able to void normally.

A. Specific gravity is decreased in clients who have hypovolemia. B. Creatinine levels are increased in clients who have acute kidney injury. C. Potassium levels are increased in clients who have polyuria. D. BUN is decreased in clients who have dehydration.

Correct Answer is B

Explanation

Choice A reason: Specific gravity is typically increased in clients who have hypovolemia, not decreased, due to the concentration of urine as the body atempts to conserve water.

Choice B reason: Creatinine levels are indeed increased in clients who have acute kidney injury, reffecting decreased kidney function and filtration.

Choice C reason: Potassium levels are not necessarily increased in clients who have polyuria. Polyuria can be associated with a variety of conditions and does not directly indicate high potassium levels.

Choice D reason: BUN, or blood urea nitrogen, is typically increased in clients who have dehydration, not decreased, due to the concentration of blood solutes as the body conserves water.

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Naxlex Comprehensive Predictor Exams

A nurse removes a client's Foley catheter and documents that the client urinates 4 hours later. Which of the following elements of postoperative care is the nurse performing?

Correct Answer is D

Explanation

A nurse is discussing laboratory values associated with the renal system with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the values?

Correct Answer is B

Explanation

A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following clients is at greatest risk for urinary retention?

A nurse is reviewing the BUN and creatinine levels of an older adult client who has chronic kidney disease (CKD). The nurse should expect which of the following findings?

A nurse is caring for a client in the emergency department with a diagnosis of renal calculi. Which of the following areas of the renal system do most renal calculi begin forming?

A nurse is assessing a client who has type 1 diabetes mellitus and has a blood glucose level of 550 mg/dL. Which of the following should the nurse assess the client for if diabetic ketoacidosis (DKA) is suspected?

A nurse is caring for a client in a clinic who has foul-smelling urine, a low-grade fever of 37.7°C (100°F), and pain with urination. Which of the following should the nurse expect the health care provider to order? (Select all that apply.)

A nurse is teaching a client who has acute kidney injury about the oliguric phase. Which of the following information should the nurse include in the teaching?