TEST BANK FOR PORTH’S PATHOPHYSIOLOGY 10TH EDITION BY NORRIS CHAPTER 32: Structure and Function of the Kidney

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1. An adult client has been diagnosed with polycystic kidney disease. Which of the client's following statements demonstrates an accurate understanding of this diagnosis? B) “I've always been prone... to getting UTIs, and now I know why.” C) “I suppose I should be tested to see if my children might inherit this.” D) “I had a feeling that I was taking too many medications, and now I know the damage they can do.” Ans: C Feedback: Autosomal dominant polycystic kidney disease is the most common of all inherited kidney diseases. The disorder is characterized by multiple expanding cysts of both kidneys that ultimately destroy the surrounding kidney structures and cause renal failure. The etiology of polycystic kidney disease (PKD) is not infective, and it is not caused by nephrotoxic drugs or uncontrolled hypertension. 2. While taking a client history, which of the following assessments lead the nurse to suspect the client may have polycystic kidney disease? Select all that apply. A) Massive proteinuria on dipstick urine specimen B) Renal colic with flank pain C) Bright red blood in urine sample D) Elevated blood pressure of 180/94 E) Shortness of breath (SOB) with loud rhonchi and wheezes heard on auscultation Ans: B, C, D Feedback: The manifestations of ADPKD include pain from the enlarging cysts that may reach debilitating levels, episodes of gross hematuria from bleeding into a cyst, infected cysts from ascending UTIs, and hypertension resulting from compression of intrarenal blood vessels with activation of the renin–angiotensin mechanism. Renal colic caused by nephrolithiasis, or kidney stones, occurs in about 20% of persons with ADPKD. One type of pain associated with kidney stones is renal colic, described as colicky pain that accompanies stretching of the collecting system or ureter. Nephrotic syndrome is characterized by massive proteinuria. SOB with abnormal respiratory sounds is not usually associated with ADPKD. 3. Which of the following statements about the use of angiotensin-converting enzyme inhibitor medications and autosomal recessive polycystic kidney disease (ARPKD) is accurate? A) The use of ACE inhibitors will increase the vasopressin levels. B) ACE inhibitors may interrupt the renin–angiotensin–aldosterone system to reduce renal vasoconstriction. C) The ACE inhibitors have been shown to shrink the size of the cysts inside the kidneys. D) ACE inhibitors should be used strictly in those clients who also have an underlying cardiac history. Ans: B Feedback: In addition to increasing water intake to decrease vasopressin levels, the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to interrupt the renin–angiotensin–aldosterone system as a means of reducing intraglomerular pressure and renal vasoconstriction. Although not approved by the Food and Drug Administration (FDA), there has been recent interest in the use of vasopressin receptor antagonists (vaptans) to decrease cyst development. [Show More]

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