The nurse cares for the client with a history of pulmonary tuberculosis (TB). Two granulomas were present in the chest x-ray. Which explanation does the nurse understand best describes the primary immune response to tuberculosis infection?

Choice A reason: Blood flow is diverted from the abdominal muscles to the liver due to increased intravascular pressure is not the best description because it is a condition that affects the distribution of blood in the body, not the accumulation of fluid in the abdomen. Intravascular pressure is the pressure exerted by the blood on the walls of the blood vessels, which can be affected by various factors, such as blood volume, cardiac output, or vascular resistance. Increased intravascular pressure can cause blood flow to be diverted from the peripheral areas, such as the abdominal muscles, to the central areas, such as the liver, which can result in symptoms such as portal hypertension, which is a high blood pressure in the vein that carries blood from the digestive organs to the liver.

Choice B reason: Vasodilation of the mesenteric blood vessels promotes movement of sodium into the peritoneum is not the best description because it is a condition that affects the diameter of the blood vessels in the abdomen, not the accumulation of fluid in the abdomen. Vasodilation is the widening of the blood vessels, which can be caused by various factors, such as nitric oxide, prostaglandins, or histamine. Vasodilation of the mesenteric blood vessels, which are the blood vessels that supply the intestines, can increase the blood flow and the permeability of the capillaries, which are the smallest blood vessels, allowing sodium and water to move from the blood to the peritoneum, which is the membrane that covers the abdominal organs and the abdominal wall. However, this is not the main mechanism for ascites development in this client, because the amount of sodium and water that moves through the capillaries is normally balanced by the lymphatic system, which is a network of vessels that drains the excess fluid and returns it to the blood.

Choice C reason: Fluid moves from the intravascular space to the interstitial space due to decreased serum albumin levels is the best description because it is a condition that affects the osmotic pressure of the blood, which is the main mechanism for ascites development in this client. Osmotic pressure is the pressure that is exerted by the solutes, such as proteins, in a solution, which determines the movement of water across a semipermeable membrane, such as the capillary wall. Albumin is the most abundant protein in the blood, which is produced by the liver and helps to maintain the osmotic pressure of the blood. Decreased serum albumin levels can be caused by various factors, such as liver failure, malnutrition, or inflammation. Decreased serum albumin levels can reduce the osmotic pressure of the blood, which means that the blood cannot retain enough water, causing fluid to move from the intravascular space, which is the space within the blood vessels, to the interstitial space, which is the space between the cells and the blood vessels. This can result in edema, which is the swelling of the tissues due to fluid accumulation, especially in the abdomen, which is called ascites.

Choice D reason: The liver metabolizes increased amounts of antidiuretic hormone and aldosterone is not the best description because it is a condition that affects the hormonal regulation of water and sodium balance, not the accumulation of fluid in the abdomen. Antidiuretic hormone and aldosterone are hormones that help the kidneys retain water and sodium, respectively, and regulate the fluid and electrolyte balance in the body. Antidiuretic hormone is produced by the hypothalamus and secreted by the pituitary gland, while aldosterone is produced by the adrenal glands. The liver is involved in the metabolism and clearance of these hormones, which means that it breaks them down and removes them from the blood. Increased amounts of antidiuretic hormone and aldosterone can be caused by various factors, such as dehydration, heart failure, or renal failure. Increased amounts of antidiuretic hormone and aldosterone can cause the kidneys to reabsorb more water and sodium, which can increase the blood volume and the blood pressure, but this is not the main mechanism for ascites development in this client, because the fluid that accumulates in the abdomen is not from the kidneys, but from the capillaries.

Choice A reason: Glomerulonephritis is an inflammation of the glomeruli, the filtering units of the kidneys. It can cause damage to the renal tissue and lead to intrinsic acute kidney injury, not prerenal acute kidney injury.

Choice B reason: Fluid volume deficit is a condition in which the body loses more fluid than it takes in. It can cause hypovolemia, which reduces the blood flow to the kidneys and impairs their function. This is the most common cause of prerenal acute kidney injury, which is a result of decreased perfusion to the kidneys.

Choice C reason: Neurogenic bladder is a dysfunction of the bladder caused by a nerve problem. It can affect the ability to store or empty urine. It can cause urinary retention, which increases the pressure in the urinary tract and damages the kidneys. This is a type of postrenal acute kidney injury, which is a result of obstruction to the urine outflow.

Choice D reason: Renal calculus is a solid mass formed from crystals in the urine. It can block the ureter, the tube that carries urine from the kidney to the bladder. It can cause hydronephrosis, which is a swelling of the kidney due to accumulation of urine. This is another type of postrenal acute kidney injury.