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 D
Explanation
Choice A rationale: Cantaloupe is high in potassium. Clients with acute kidney injury (AKI) have impaired potassium excretion, and consuming high-potassium foods increases the risk of hyperkalemia, which can lead to cardiac arrhythmias.
Choice B rationale: Baked potatoes contain significant potassium, especially in the skin. In AKI, potassium retention is dangerous, so this choice reflects poor understanding of dietary restrictions for renal safety.
Choice C rationale: Yogurt is rich in potassium and phosphorus. In AKI, both electrolytes may accumulate due to reduced renal clearance, making yogurt an inappropriate choice without close monitoring.
Choice D rationale: Pecans are low in potassium, making them a safer snack for clients with AKI. Choosing low-potassium foods demonstrates appropriate understanding of renal dietary management.
Correct Answer is B
Explanation
Choice A reason: Back pain is a physical symptom of UTIs, not a psychosocial effect.
Choice B reason: Missing out on normal social activities like atending grandchildren's school events indicates a psychosocial impact from frequent UTIs.
Choice C reason: Needing to be close to a bathroom is a practical concern due to the physical symptoms of UTIs, not a psychosocial effect.
Choice D reason: Nausea and vomiting are physical symptoms of UTIs and do not directly indicate a psychosocial effect.
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