A client with a history of hypertension has a urine analysis ordered. Which finding would warrant additional assessment?
Negative for glucose
Negative for white blood cells
Positive for protein
Positive for creatinine
The Correct Answer is C
Choice A reason: Negative glucose in urine is normal, as the kidneys reabsorb glucose unless blood levels exceed 180 mg/dL (e.g., in diabetes). In hypertension, this finding does not indicate renal damage or require further assessment, as it aligns with normal renal function and glucose handling.
Choice B reason: Negative white blood cells in urine suggest no urinary tract infection or inflammation, a normal finding. In hypertensive patients, this does not signal kidney damage or other complications, so no additional assessment is needed, as it indicates an absence of acute inflammatory processes.
Choice C reason: Proteinuria (positive protein) indicates potential renal damage, common in hypertension due to glomerular injury from elevated pressure. It suggests impaired filtration, allowing proteins like albumin to leak into urine. This finding warrants further assessment, such as quantifying protein levels or evaluating kidney function, making it the correct choice.
Choice D reason: Creatinine in urine is normal, as it is a waste product excreted by the kidneys. While serum creatinine assesses renal function, urinary creatinine presence is expected and does not indicate pathology in hypertension, so it does not require additional assessment in this context.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Melena, dark tarry stools from digested blood, indicates upper gastrointestinal bleeding, not typically GERD. GERD involves acid reflux causing esophageal irritation, not bleeding severe enough for melena. This statement is inaccurate, as melena is more associated with ulcers or varices, not reflux disease.
Choice B reason: Heartburn, a burning sensation in the chest, is a hallmark of GERD, caused by stomach acid refluxing into the esophagus, irritating the mucosa. It results from lower esophageal sphincter dysfunction, allowing acid backflow. This statement is accurate, as heartburn is a primary diagnostic symptom of GERD.
Choice C reason: Hematemesis, vomiting blood, is not a common GERD symptom but indicates severe conditions like esophageal varices or ulcers. While chronic GERD may lead to esophagitis, bleeding is rare. This statement is inaccurate, as hematemesis is not a characteristic feature of typical GERD presentations.
Choice D reason: Dysphagia, difficulty swallowing, can occur in severe GERD due to esophageal strictures or motility issues but is not a primary characteristic. Heartburn is more common and diagnostic. This statement is less accurate, as dysphagia is a complication, not a defining feature of GERD.
Correct Answer is C
Explanation
Choice A reason: Bladder cancer primarily affects the bladder, causing hematuria or obstruction, leading to post-renal injury, not intra-renal. Intra-renal damage involves nephron injury, which is less likely with bladder cancer unless advanced metastasis affects kidneys, making this patient less at risk than one on nephrotoxic chemotherapy.
Choice B reason: Benign prostatic hyperplasia causes urinary obstruction, leading to post-renal kidney injury from backpressure, not intra-renal damage. The kidneys’ nephrons are not directly harmed by BPH, making this 65-year-old male less at risk for intra-renal injury compared to a patient receiving nephrotoxic drugs.
Choice C reason: Chemotherapy, especially agents like cisplatin, is nephrotoxic, causing intra-renal acute kidney injury by damaging renal tubules. This 25-year-old female faces high risk due to direct tubular toxicity, leading to acute tubular necrosis, making her the most likely to develop intra-renal injury among the options.
Choice D reason: Renal artery stenosis causes pre-renal kidney injury by reducing renal perfusion, not intra-renal damage. The nephrons remain intact unless chronic ischemia leads to secondary damage. This 36-year-old female has a lower risk of intra-renal injury compared to the chemotherapy patient’s direct nephrotoxic exposure.
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