Which of the following are causes of intrarenal acute kidney injury? (Select all that apply.)
Hemoglobin from hemolyzed RBCs
Benign prostatic hyperplasia
Prostate cancer
Myoglobin release from necrotic muscle cells
Nephrotoxins
Correct Answer : A,D,E
Choice A rationale
Hemoglobin released from hemolyzed red blood cells (RBCs) can cause intrarenal acute kidney injury by obstructing the renal tubules and damaging the nephrons.
Choice B rationale
Benign prostatic hyperplasia is a cause of postrenal, not intrarenal, acute kidney injury as it can obstruct the flow of urine out of the bladder.
Choice C rationale
Prostate cancer, similar to benign prostatic hyperplasia, typically leads to postrenal acute kidney injury due to urinary obstruction.
Choice D rationale
Myoglobin released from necrotic muscle cells, as seen in conditions like rhabdomyolysis, can cause intrarenal acute kidney injury by precipitating in the renal tubules.
Choice E rationale
Nephrotoxins, such as certain medications, chemicals, or toxins, can directly damage the kidney tissue, leading to intrarenal acute kidney injury.
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Correct Answer is C
Explanation
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.
Correct Answer is A
Explanation
Choice A rationale
This method is the standard procedure for obtaining a clean-catch midstream urine specimen. The initial voiding washes away organisms near the meatus, and the midstream urine is less likely to be contaminated by bacteria from the skin or urethral area, providing a sample that more accurately represents the bacteria in the bladder.
Choice B rationale
Having the patient empty the bladder completely and then obtaining the next specimen does not ensure a clean-catch sample. This method could lead to contamination of the specimen with bacteria from the skin or urethral area.
Choice C rationale
Cleaning the area with povidone-iodine is not recommended for routine urine culture as it may kill some of the bacteria, leading to a false-negative result. The standard practice is to clean the area with mild soap and water.
Choice D rationale
Inserting a catheter is an invasive procedure and is not the first choice for obtaining a urine specimen. It is used when a patient is unable to provide a clean-catch specimen or if there are specific medical indications.
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