A client is diagnosed with post-streptococcal glomerulonephritis. Which symptom should the nurse expect?
Dark, cloudy urine and facial edema
Elevated serum calcium
Sudden onset of severe flank pain:
Excessive concentrated urine output and low blood pressure
The Correct Answer is A
Rationale:
A. Dark, cloudy urine and facial edema are hallmark features of post-streptococcal glomerulonephritis (PSGN). PSGN is an immune-mediated disorder that develops after infection with nephritogenic strains of Streptococcus pyogenes, typically following a throat or skin infection. Immune complexes deposit in the glomeruli, leading to inflammation and damage to the filtration barrier. This results in hematuria, causing dark or tea-colored urine, and proteinuria, which contributes to fluid retention. Sodium and water retention lead to edema, often first noticeable in the periorbital area, and hypertension may also develop due to volume expansion.
B. Elevated serum calcium is not associated with PSGN. Calcium levels in the blood are primarily regulated by parathyroid hormone, vitamin D, and renal excretion of calcium. PSGN primarily affects glomerular filtration and fluid balance, not calcium metabolism. Any abnormalities in calcium would likely be incidental or due to other conditions, not a direct consequence of post-streptococcal glomerulonephritis.
C. Sudden onset of severe flank pain is more typical of renal calculi (kidney stones) or acute pyelonephritis. Kidney stones can obstruct urine flow, causing sharp, colicky flank pain radiating to the groin. Pyelonephritis, an infection of the renal pelvis, may cause flank pain accompanied by fever and urinary symptoms. PSGN, however, does not usually produce acute pain; its manifestations are primarily related to glomerular inflammation and fluid retention rather than obstruction or infection.
D. Excessive concentrated urine output and low blood pressure is inconsistent with PSGN. In PSGN, the glomerular injury reduces filtration, often causing oliguria (reduced urine output). Retained sodium and water contribute to fluid overload and hypertension rather than hypotension. Excessively concentrated urine is more characteristic of conditions with high antidiuretic hormone activity or dehydration, not post-infectious glomerulonephritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. In emphysema, destruction of alveolar walls and loss of elastic recoil lead to air trapping and hyperinflation of the lungs. Over time, this causes the diaphragm to flatten as the lungs expand, which is a classic radiographic sign of advanced emphysema. This finding correlates with reduced ventilatory efficiency, increased work of breathing, and progressive respiratory compromise.
B. In emphysema, breath sounds are often decreased due to the destruction of alveoli and hyperinflation of the lungs. Loud or increased breath sounds are more typical in conditions such as bronchospasm or pulmonary edema with turbulent airflow.
C. While early emphysema may present with minimal auscultatory findings and a mild cough, advanced disease is associated with hyperinflated lungs, decreased breath sounds, and sometimes wheezing. Clear lung fields alone do not indicate severe or advanced disease.
D. Bradycardia and constricted pupils are incorrect. These findings are unrelated to emphysema. Bradycardia and miosis may suggest medication effects (e.g., opioids) or neurologic conditions, not pulmonary pathology.
Correct Answer is C
Explanation
Rationale:
A. High urine pH is not a primary factor contributing to recurrent UTIs in older men. While urine pH can influence bacterial growth, it is not the most significant predisposing factor in this population.
B. Use of cotton underwear is more relevant for women, as cotton can help reduce moisture and bacterial growth. In older men, underwear type has minimal impact on UTI risk, especially compared with underlying urinary tract abnormalities.
C. Urine retention caused by prostatic hypertrophy is correct. In older men, benign prostatic hyperplasia (BPH) is common and can partially obstruct urine flow. This obstruction leads to urinary stasis, which provides a favorable environment for bacterial proliferation and increases the risk of recurrent urinary tract infections. Chronic retention can also lead to incomplete bladder emptying, further exacerbating infection risk.
D. Increased fluid intake is protective, not causative. Adequate hydration helps flush bacteria from the urinary tract and reduces the likelihood of infection.
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