Which client is at greatest risk of acute intra-renal kidney injury?
A 54-year-old male with bladder cancer
A 65-year-old male with benign prostatic hyperplasia
A 25-year-old female receiving chemotherapy for cancer
A 36-year-old female with renal artery stenosis
The Correct Answer is C
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Morning stiffness lasting 25 minutes suggests mild joint inflammation but is not specific to rheumatoid arthritis (RA). RA typically involves stiffness exceeding 30-60 minutes and multiple joints bilaterally. This symptom alone is less indicative than red, spongy joints, making this choice less likely for RA.
Choice B reason: Crepitus in the right knee indicates cartilage wear, more characteristic of osteoarthritis than RA. RA causes synovial inflammation, not primarily crepitus. This 45-year-old male’s symptom suggests mechanical joint issues, not the inflammatory, systemic features of RA, making this choice incorrect.
Choice C reason: Red, soft, spongy joints in both knees indicate synovial inflammation and effusion, hallmark signs of RA. This autoimmune disease causes bilateral joint swelling, warmth, and tenderness due to synovitis. This 30-year-old female’s symptoms align with RA’s clinical presentation, making this the most likely manifestation.
Choice D reason: Osteophyte formation and decreased joint space are typical of osteoarthritis, not RA. RA involves synovial inflammation and cartilage erosion without osteophytes early on. This 40-year-old male’s findings suggest degenerative joint disease, not the inflammatory changes of RA, making this choice incorrect.
Correct Answer is A
Explanation
Choice A reason: Crush injuries release myoglobin from damaged muscles, causing rhabdomyolysis. Myoglobin precipitates in renal tubules, obstructing them and leading to acute tubular necrosis, an intra-renal acute kidney injury. This toxic effect, combined with oxidative stress, impairs filtration, making this statement accurate for the pathophysiology of renal injury.
Choice B reason: Large IV fluid volumes are used to prevent renal injury in rhabdomyolysis by diluting myoglobin and maintaining perfusion. Fluid overload may cause pulmonary edema but does not typically cause pre-renal damage, which results from hypoperfusion. This statement is inaccurate, as fluids are protective, not harmful.
Choice C reason: Pain medications like NSAIDs can be nephrotoxic, causing intra-renal damage by reducing renal blood flow or causing interstitial nephritis. However, pre-renal damage results from hypoperfusion, not direct toxicity. In crush injuries, myoglobin is the primary cause, making this statement less accurate than myoglobin-related tubular damage.
Choice D reason: Significant blood loss causes pre-renal injury by reducing renal perfusion, not post-renal damage, which involves urinary obstruction. Crush injuries primarily cause intra-renal damage via myoglobin. This statement is inaccurate, as it misattributes the mechanism and type of renal injury in this context.
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