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

Explanation

Choice A rationale

An increasing hemoglobin level does not indicate the resolution of acute pancreatitis. Hemoglobin levels can fluctuate due to various factors, including hydration status and blood loss, but are not directly related to the resolution of pancreatitis.

Choice B rationale

During an episode of acute pancreatitis, serum concentrations of amylase and lipase rise significantly, often within hours of pancreatic injury. These elevated enzyme levels are key components in diagnosing the condition. As the inflammation subsides and the pancreas begins to heal, the levels of these enzymes typically decrease, returning to normal ranges. Therefore, a declining serum amylase level suggests that the acute inflammatory process is resolving.

Choice C rationale

Serum bilirubin levels are indicative of liver function and bile metabolism. Elevated bilirubin may occur if pancreatitis leads to bile duct obstruction or liver involvement. However, a decrease in bilirubin levels addresses biliary system recovery rather than directly reflecting pancreatic inflammation resolution.

Choice D rationale

An increasing serum alkaline phosphatase level is generally associated with bile duct obstruction or bone disease and does not indicate the resolution of acute pancreatitis. This enzyme is found in several tissues throughout the body, including the liver and bones.

A. The client states that they consume a high calcium diet and have had high calcium in their blood. B. The client reports that they took a lot of ibuprofen for arthritis for many years. C. The client reports that they had two urinary tract infections (UTIs) in the past 10 months. D. The client states that they remember their mother saying their grandmother had this same genetic disease.

Correct Answer is C

Explanation

Choice A rationale
A high calcium diet and hypercalcemia are not directly associated with pyelonephritis. While dietary habits and blood calcium levels can impact overall health, they do not typically contribute to the development of pyelonephritis.

Choice B rationale
Long-term use of ibuprofen can lead to kidney damage, which may increase the risk of pyelonephritis, especially if there is pre-existing kidney impairment. However, it is not as directly related to pyelonephritis as a history of UTIs.

Choice C rationale
A history of UTIs is relevant to pyelonephritis, as the infection can ascend from the lower urinary tract to the kidneys. Recurrent UTIs are a risk factor for pyelonephritis, making this the most likely report from the client.

Choice D rationale
Genetic diseases can have various impacts on health, but there is no common genetic disease that directly causes pyelonephritis. This choice is less likely to be relevant to the client's current condition.

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Naxlex Comprehensive Predictor Exams

Which laboratory finding indicates the resolution of a patient's acute pancreatitis?

Correct Answer is B

Explanation

A nurse is gathering medical history from a client admitted for pyelonephritis. Which of the following should the nurse expect the client to report when asked about their medical history?

Correct Answer is C

Explanation

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.)

Which clinical manifestation of inflammatory bowel disease is common to both patients with ulcerative colitis (UC) and Crohn's disease?

Which laboratory finding indicates the resolution of a patient's acute pancreatitis?

A nurse is teaching a client who has peripheral venous disease about the management of symptoms. Which of the following client statements indicates an understanding of the teaching?

A nurse is educating the public at a health fair about colorectal cancer. Which of the following risk factors increase the risk of developing colorectal cancer? (Select all that apply.)

A nurse is teaching a client who has chronic kidney disease about limiting foods that are high in potassium. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.)

A 72-year-old patient was admitted with epigastric pain caused by a peptic ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

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?