Chapter 21: Kidney Disease Nursing School Test Banks

Chapter 21: Kidney Disease
Test Bank

MULTIPLE CHOICE

1. The microscopic functional units of the kidney are called
a. nephrons.
b. glomeruli.
c. tubules.
d. loops of Henle.
ANS: A
The nephron is the function unit of the kidney. It performs functions such as filtration, reabsorption, secretion, and excretion.

DIF: Cognitive Level: Knowledge REF: 425 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The structure responsible for filtering the blood is the
a. loop of Henle.
b. proximal tubule.
c. distal tubule.
d. glomerulus.
ANS: D
The glomerulus filters the blood. Only the larger blood proteins and cells remain behind in the circulating blood as it leaves the glomerulus.

DIF: Cognitive Level: Knowledge REF: 425-426 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. Disease conditions that can interfere with normal nephron function include
a. obstruction and infection.
b. chronic caffeine intake.
c. chronic alcohol abuse.
d. anemia.
ANS: A
Obstruction and infection can interfere with normal nephron function.

DIF: Cognitive Level: Knowledge REF: 428 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. Glomerulonephritis or nephritic syndrome is one of the causes of
a. stage 5 CKD or ESRD.
b. stage 1 CKD.
c. kidney stones.
d. heart failure.
ANS: A
Glomerulonephritis is one of the three most common causes of stage 5 CKD.

DIF: Cognitive Level: Knowledge REF: 429
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. Clinical symptoms associated with chronic kidney disease do not include
a. anemia.
b. diabetes mellitus.
c. hypertension.
d. bone pain.
ANS: B
Complications of chronic kidney disease do not include diabetes mellitus.

DIF: Cognitive Level: Knowledge REF: 428 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. The presence of protein in the urine is called
a. hematuria.
b. oliguria.
c. proteinuria.
d. anuria.
ANS: C
Proteinuria results from an abnormal excess of serum proteins in the urine.

DIF: Cognitive Level: Knowledge REF: 429-430 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. Classic symptoms of acute glomerulonephritis include
a. azotemia.
b. proteinuria.
c. ascites.
d. anemia.
ANS: B
Classic symptoms of acute glomerulonephritis include hematuria and proteinuria, although edema and hypertension also may occur.

DIF: Cognitive Level: Knowledge REF: 429-430
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. Azotemia refers to elevated blood levels of
a. glucose.
b. cholesterol.
c. amines.
d. urea.
ANS: D
Elevated blood levels of urea nitrogen and other nitrogenous products are reflected in the characteristic laboratory finding of azotemia.

DIF: Cognitive Level: Knowledge REF: 433 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. Nephrotic syndrome, or nephrosis, is a disease that
a. is caused by chronic hypertension.
b. allows large amounts of protein to escape into the tubule.
c. causes the buildup of toxic wastes in the blood.
d. results in the formation of kidney stones.
ANS: B
Nephrotic syndrome, or nephrosis, results from nephron tissue damage to both the glomerulus and tubule. The primary damage is to the major filtering membrane of the glomerulus, which allows large amounts of protein to pass into the tubule.

DIF: Cognitive Level: Knowledge REF: 430 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The massive edema of nephrotic syndrome is caused by
a. blockage in the nephron tubules.
b. excessive fluid intake.
c. large protein losses in the urine.
d. a diet too high in sodium.
ANS: C
In nephrotic syndrome, large amounts of protein pass into the tubule. The large protein loss leads to massive edema and ascites as well as proteinuria.

DIF: Cognitive Level: Application REF: 430 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. Medical nutrition therapy for nephrotic syndrome includes
a. high protein intake.
b. moderate protein intake.
c. high potassium intake.
d. fluid restriction.
ANS: B
Medical nutrition therapy for nephrotic syndrome includes moderate protein intake, at 0.8 g/kg/day to meet nutritional and growth needs and without excess.

DIF: Cognitive Level: Application REF: 430 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

12. The hormone that causes the kidneys to reabsorb water and decrease urine production is
a. renin.
b. vitamin D.
c. erythropoietin.
d. antidiuretic hormone.
ANS: D
Antidiuretic hormone (ADH) works on the distal nephron tubule to conserve water by reabsorption.

DIF: Cognitive Level: Application REF: 427 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The sudden shutdown of kidney function as the result of traumatic injury is called
a. nephrosis.
b. glomerulonephritis.
c. acute kidney failure.
d. chronic kidney failure.
ANS: C
Acute kidney failure results when renal function in healthy kidneys shuts down suddenly after some metabolic insult or traumatic injury, causing a life-threatening situation. This is a medical emergency.

DIF: Cognitive Level: Knowledge REF: 431 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. A major clinical symptom of acute kidney failure is
a. hematuria.
b. proteinuria.
c. oliguria.
d. massive edema.
ANS: C
A major symptom of acute kidney failure is oliguria, which is caused when the cellular debris from the tissue damage blocks the renal tubules.

DIF: Cognitive Level: Knowledge REF: 431 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. A progressive increase in serum urea levels occurs in
a. acute renal failure.
b. glomerulonephritis.
c. chronic kidney failure.
d. nephrotic syndrome.
ANS: C
A progressive increase in serum urea levels occurs in chronic kidney failure. Increasing loss of nephron function results in elevated amounts of nitrogenous metabolites, such as urea.

DIF: Cognitive Level: Knowledge REF: 433
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. Ms. Jones comes to the emergency department with a severe drug reaction to penicillin. She may be at risk for
a. diabetes or heart disease.
b. high sodium intake.
c. protein-energy malnutrition.
d. acute kidney failure.
ANS: D
Acute kidney failure can result from drug reactions in allergic or sensitive persons, such as a reaction to antibiotics (such as penicillin) or antimicrobial agents.

DIF: Cognitive Level: Application REF: 431
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. Mr. Brady has chronic kidney disease. He is 55 years of age, weighs 165 lbs, and has a GFR of 22mL/min. His estimated energy needs per day are approximately
a. 2200 kcal/d.
b. 2350 kcal/d.
c. 2625 kcal/d.
d. 2850 kcal/d.
ANS: C
Carbohydrate and fat must provide enough energy to spare protein, and for those individuals who are younger than 60 years of age with CKD and GFRs less than 25 mL/min, 35 kcal/kg/day are required to meet this need. In this case, 165 lbs = 75 kg. 75 kg x 35 kcal/kg/d = 2625 kcal.

DIF: Cognitive Level: Application REF: 434 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

18. The bone disease called osteodystrophy is associated with
a. glomerulonephritis.
b. acute renal failure.
c. chronic renal failure.
d. nephrotic syndrome.
ANS: C
The disturbed metabolism of calcium and phosphate from lack of vitamin D, a process that occurs in the kidneys, leads to bone pain from osteodystrophy in patients with chronic renal failure.

DIF: Cognitive Level: Knowledge REF: 432-433 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Reduction of Risk Potential

19. The classic symptoms of chronic kidney failure result from
a. a diet high in sodium.
b. a diet chronically low in fluid intake.
c. severe trauma to the body.
d. progressive loss of nephrons.
ANS: D
Chronic kidney failure, or chronic renal insufficiency, is caused by the progressive breakdown of renal tissues, which impairs all renal function. Few functioning nephrons remain, and they gradually deteriorate.

DIF: Cognitive Level: Application REF: 432 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. The bone disease osteodystrophy develops because of the kidneys inability to
a. excrete calcium.
b. activate vitamin D.
c. absorb vitamin D.
d. excrete urea.
ANS: B
The disturbed metabolism of calcium and phosphate from lack of vitamin D activation, a process that occurs in the kidneys, leads to bone pain from osteodystrophy.

DIF: Cognitive Level: Knowledge REF: 433
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. Symptoms of chronic kidney failure include
a. nitrogen retention.
b. euphoria.
c. jaundice.
d. inability to sleep.
ANS: A
Symptoms of chronic kidney disease include fluid imbalances, electrolyte imbalances, nitrogen retention, anemia, hypertension, and azotemia.

DIF: Cognitive Level: Knowledge REF: 433
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. Carbohydrates and fats are important in the diets of patients with kidney disease because they
a. prevent fatigue.
b. spare protein for tissue synthesis.
c. are low in sodium.
d. are metabolized before they reach the kidney.
ANS: B
Carbohydrate and fat must supply sufficient nonprotein kilocalories to supply energy and spare protein for tissue synthesis.

DIF: Cognitive Level: Knowledge REF: 434 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation, Health Promotion and Maintenance

23. The cleaning solution used in hemodialysis is called the
a. filtrate.
b. plasma.
c. urine.
d. dialysate.
ANS: D
The cleaning solution used in hemodialysis is called the dialysate.

DIF: Cognitive Level: Knowledge REF: 434 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The method of dialysis that allows patients to be mobile is
a. hemodialysis.
b. renal dialysis.
c. peritoneal dialysis.
d. continuous dialysis.
ANS: C
Peritoneal dialysis is an alternative form of treatment for dialysis that allows patients to be mobile. In this process, the patient introduces the dialysate solution directly into the peritoneal cavity 4 or 5 times a day, where it can be exchanged for fluids that contain the metabolic waste products.

DIF: Cognitive Level: Knowledge REF: 437 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. The patient treated by peritoneal dialysis can increase _____ intake.
a. protein
b. phosphorus
c. caloric
d. fat
ANS: A
The patient treated by peritoneal dialysis can increase protein intake to 1.2 to 3 g/kg body weight as a result of a more liberal diet.

DIF: Cognitive Level: Knowledge REF: 437 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. For patients with uric acid stones, health practitioners may recommend a diet low in
a. calcium.
b. vegetable protein.
c. animal protein.
d. fat.
ANS: C
Excess excretion of uric acid may be caused by some impairment with the metabolism of purine, a nitrogen end product of dietary protein from which uric acid is formed.

DIF: Cognitive Level: Knowledge REF: 443 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. One of the first recommendations for any type of kidney stone is to
a. increase the fiber in the diet.
b. reduce calcium intake.
c. increase fluid intake.
d. decrease protein intake.
ANS: C
A large fluid intake is a primary therapy that helps produce more dilute urine and prevent accumulation of materials that form stones.

DIF: Cognitive Level: Knowledge REF: 444 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. The most common type of kidney stone is composed of
a. calcium.
b. uric acid.
c. cystine.
d. magnesium.
ANS: A
The most common type of kidney stone (approximately 80%) is composed of calcium oxalate or calcium phosphate.

DIF: Cognitive Level: Knowledge REF: 440 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. The type of diet recommended for a person with a calcium stone depends on
a. body weight.
b. the composition of the stone.
c. fiber intake.
d. fluid intake.
ANS: B
Medical nutrition therapy for calcium stones depends on the composition of the stone. If a stone is composed of calcium phosphate, additional sources of phosphorus should be controlled. If a stone is calcium oxalate, foods high in oxalate should be avoided.

DIF: Cognitive Level: Knowledge REF: 444 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. Patients with chronic renal disease may need to restrict their intake of foods high in phosphorus, such as
a. milk, nuts, and legumes.
b. meat, chicken, and fish.
c. bread, cereal, rice, and pasta.
d. fruit and potatoes.
ANS: A
Phosphorus-containing foods include milk, nuts, and legumes.

DIF: Cognitive Level: Application REF: 433-434|444 TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

31. For patients treated with dialysis, a good source of protein could be
a. sherbet.
b. green beans.
c. scrambled egg.
d. apple crisp.
ANS: C
Eggs are a high-biologic value protein for patients on dialysis.

DIF: Cognitive Level: Application REF: 435
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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