NUR 280 Renal Quiz - heightened risk of diabetic nephropathy. Which ...

NUR 280 Renal Quiz

• The most recent assessment of a patient with a diagnosis of type 1 diabetes indicates a

heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk?

• Orthostatic hypotension
• Hematuria
• Microalbuminuria

D. Diabetic retinopathy:

Answer

Microalbuminuria Feedback

The increased glomerular filtration rate (GFR) that occurs in persons with early alterations in renal function is associated with microalbuminuria, which is an important predictor of future diabetic nephropathies. Hematuria is not directly suggestive of diabetic nephropathy, although it is a highly significant assessment finding. Orthostatic hypotension and diabetic retinopathy are not direct indicators of diabetic retinopathy.

• As chronic kidney disease progresses, the second stage (renal insufficiency) is identified

by:

• metabolic acidosis.
• isotonic polyuria.
• hyperparathyroidism.

D. diminished renal reserve.:

Answer

isotonic polyuria.Feedback

Diminished renal reserve is characteristic of renal insufficiency, when labs remain normal and renal insufficiency. Only the second stage, renal insufficiency, is characterized by polyuria that is isotonic. Metabolic acidosis develops later as a result of the kidneys being unable to eliminate hydrogen ions. Hyperparathyroidism occurs in kidney failure, as a compensatory change in 1 / 3

response to chronically low serum calcium and phosphate retention.

3. 1) A characteristic manifestation of polycystic kidney disease is:

• hypertension.
• alkaline urine.
• renal colic.
• massive proteinuria.

Answer

• hypertension.

Feedback Polycystic kidney disease, which can be inherited as a Mendelian trait, results in the formation of fluid-filled cysts in kidneys, hypertension, cardiovascular abnormalities, cerebral aneurysms, and cyst formation in other organs such as the liver and pan- creas. When present, urinary calculi serve as foreign bodies and contribute to renal infection, often caused by urea- splitting organisms (e.g., Proteus, staphylococci) that increase ammonia production and cause the urine to become alkaline. One type of pain associated with kidney stones is renal colic, described as colicky pain that accompanies stretching of the collecting system or ureter.Nephrotic syndrome is characterized by massive proteinuria.

• 2) A patient had excessive blood loss and prolonged hypotension during surgery. His

postoperative urine output is sharply decreased and his blood urea nitrogen (BUN) is elevated.

The most likely cause for the change is acute:

• prerenal inflammation.
• ischemic tubular necrosis.
• intrarenal nephrotoxicity.
• bladder outlet obstruction.

Answer

• ischemic tubular necrosis. Feedback

Ischemic acute tubular necrosis (ATN) occurs most frequently in persons who have major surgery with prolonged renal hypoperfusion—this directly damages the tubules. Nephrotoxic ATN is caused by toxic agents or drugs. Prerenal vasoconstriction is associated with acute onset loss of renal output. Bladder (postrenal) obstruction would not affect the BUN, since it rarely causes renal failure.

• 3) A patient has a diagnosis of chronic renal failure secondary to diabetic nephropathy.

Which of the following hematologic changes may result from this patient's kidney disorder?

• Thrombocytopenia
• Anemia
• Leukocytosis
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• Leukopenia

Answer

• Anemia Feedback

Because of the central role of the kidneys in the production of erythropoietin, individuals with kidney disease may be prone to anemia. Changes in platelet or white blood cell levels are not likely to result directly from renal failure.

• 4) A patient is beginning to recover from acute tubular necrosis. The recovery phase of

ATN is

characterized by:

• proteinuria.
• hypokalemia.
• diuresis.

D. edema.:

Answer

• diuresis.

Feedback The recovery phase is first noticed as increased/excessive output (diuresis) of dilute urine.Potassium will remain elevated or continue to rise, since the diuresis occurs before renal function fully returns to normal. Edema/fluid retention is characteristic of the maintenance phase. Proteinuria is characteristic of glomerular disease and/or chronic kidney disease.A patient with significant burns on his lower body has developed sepsis on the third day following his accident. Which of the following developments is most clearly suggestive of ischemic acute tubular necrosis rather than prerenal failure?

• A patient with significant burns on his lower body has developed sepsis on the third day

following his accident. Which of the following developments is most clearly suggestive of ischemic acute tubular necrosis rather than prerenal failure?

• The patient exhibits pulmonary and peripheral edema.
• The patient's GFR does not increase after restoration of renal blood flow.
• Emergency hemodialysis does not result in decreased BUN and creatinine.

D. The patient exhibits oliguria and frank hematuria.:

Answer

The patient's GFR does not increase after restoration of renal blood flow.

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