A nurse is caring for a client who has an acute kidney injury caused by acute tubular necrosis. The client 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?

Inflammatory cells invade the already damaged kidneys.

There is a reduction of blood flow to the kidneys.

There is injury to the renal tubular cells.

There is obstruction leading to the filtration system backing up and eventually shutting the kidneys down.

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is ["B","C","E","F"]

Explanation

Choice A rationale
Hypertension is not a typical manifestation of pyelonephritis. While it can be present due to other underlying conditions, it is not directly related to pyelonephritis.

Choice B rationale
Frequency, or the need to urinate more often, is a common symptom of pyelonephritis as the infection can irritate the bladder and urinary tract.

Choice C rationale
Flank pain is a classic symptom of pyelonephritis. It is usually located on the side of the affected kidney and can be quite severe.

Choice D rationale
Neck pain is not associated with pyelonephritis. It is more likely related to musculoskeletal issues or other non-urinary tract conditions.

Choice E rationale
Costovertebral tenderness, which is tenderness felt on tapping the back where the ribs meet the spine, is indicative of kidney infection and is expected in pyelonephritis.

Choice F rationale
Urgency, or a sudden, strong need to urinate, is another symptom of pyelonephritis due to inflammation and irritation in the urinary system.

A. Regular diet, no added salt B. Low-protein, low-potassium diet C. Low-carbohydrate, low-protein diet D. Low-sodium, fluid-restricted diet

Correct Answer is D

Explanation

Choice A rationale
A regular diet with no added salt may not be sufficient to address the fluid retention associated with acute glomerulonephritis and peripheral edema.

Choice B rationale
While a low-protein, low-potassium diet may be considered for certain kidney conditions, it does not specifically address the fluid and sodium management needed in acute glomerulonephritis with edema.

Choice C rationale
A low-carbohydrate, low-protein diet is not indicated in this scenario as it does not provide the necessary restrictions on sodium and fluid that are required for a child with edema and oliguria due to acute glomerulonephritis.

Choice D rationale
A low-sodium, fluid-restricted diet is most appropriate for a child with acute glomerulonephritis and peripheral edema. This diet helps manage the edema and prevent further fluid overload, which is crucial in the care of this condition.

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Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has pyelonephritis. Which of the following manifestations should the nurse expect to be present during the assessment? (Select all that apply.)

Correct Answer is ["B","C","E","F"]

Explanation

A nurse is caring for a school-age child who has acute glomerulonephritis with peripheral edema and is producing 35 mL of urine per hour. The nurse should place the client on which of the following diets?

Correct Answer is D

Explanation

A nurse is providing teaching on common symptoms of glomerulonephritis. What assessment findings are consistent with this diagnosis? (Select all that apply.)

A female patient with a suspected urinary tract infection is to provide a clean-catch midstream urine specimen for culture and sensitivity testing. What should the nurse do to obtain the specimen?

How will the nurse assess for flank tenderness in a patient with suspected pyelonephritis?

Which action will the nurse take when assessing a patient with possible oral cancer?

A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values?

A nurse is developing a plan of care for a client who has a new ileal conduit. Which of the following should the nurse include as risks for the client? (Select all that apply.)

A patient who has is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the acute glomerulonephritis prescribed calcium gluconate IV?