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

Answer and Explanation

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.

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Correct Answer is A

Explanation

Choice A reason: Elevated rheumatoid factor (RF), an autoantibody, is present in 70-80% of rheumatoid arthritis (RA) patients. It contributes to immune complex formation, driving synovial inflammation and joint damage. This lab result is a key diagnostic marker, making it consistent with RA and critical for confirming the diagnosis.

Choice B reason: Decreased C-reactive protein (CRP) is inconsistent with RA, which typically shows elevated CRP due to systemic inflammation. CRP reflects acute-phase response in active RA, and low levels suggest inactive disease or another condition, making this result inaccurate for supporting an RA diagnosis.

Choice C reason: Normal erythrocyte sedimentation rate (ESR) is not typical in active RA, where ESR is elevated due to inflammation-driven increases in plasma proteins. Normal ESR may occur in remission but does not support an active RA diagnosis, making this result inconsistent with the condition.

Choice D reason: Low antinuclear antibody (ANA) levels are not specific to RA and are more associated with systemic lupus erythematosus. While some RA patients may have low ANA, it is not a diagnostic marker for RA, making this result irrelevant and inconsistent with confirming rheumatoid arthritis.

A. Too much absorption of bile acids B. History of elevated serum calcium C. History of elevated cholesterol in the diet D. Inflammation of epithelial tissue

Correct Answer is B

Explanation

Choice A reason: Excessive bile acid absorption, often due to ileal dysfunction, reduces bile acid availability in the gallbladder, promoting cholesterol supersaturation and gallstone formation. This contributes to cholelithiasis, particularly cholesterol gallstones, by altering bile composition, making this condition a significant risk factor, not the least likely.

Choice B reason: Elevated serum calcium (hypercalcemia) is not directly linked to cholelithiasis. While hypercalcemia can cause kidney stones, gallstone formation is driven by bile composition changes, like cholesterol or bile acid imbalances, not serum calcium levels. This makes it the least likely contributor to gallstone development.

Choice C reason: Elevated dietary cholesterol increases hepatic cholesterol secretion into bile, leading to supersaturation and cholesterol gallstone formation. This is a well-established risk factor for cholelithiasis, as excess cholesterol overwhelms bile acid and phospholipid solubilization, promoting crystal formation, making it a significant contributor, not the least likely.

Choice D reason: Inflammation of epithelial tissue, such as in chronic cholecystitis, promotes gallstone formation by altering gallbladder motility and bile stasis. Inflammatory changes disrupt bile acid metabolism and increase mucin production, facilitating stone nucleation. This condition is a known risk factor for cholelithiasis, not the least likely contributor.

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Which client is at greatest risk of acute intra-renal kidney injury?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which lab result would be consistent with a diagnosis of rheumatoid arthritis?

Correct Answer is A

Explanation

A client is diagnosed with cholelithiasis. Which condition is least likely to lead to this disorder?

Correct Answer is B

Explanation

Which patient below is at greatest risk for developing gout?

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A client who has been diagnosed with bladder cancer is scheduled for an ileal conduit. Which statement by the nurse to the client accurately describes the ileal conduit?