Renal -Glomeronephritis

A set of vocabulary flashcards covering key concepts and definitions related to the urinary system, including UTIs, incontinence, kidney damage, and treatments.

Which findings characterize the clinical manifestation of Acute Glomerulonephritis? (Select all that apply)

• A. Periorbital edema

• B. Generalized hypotension

• C. Cola-colored urine

• D. Massive proteinuria

• E. Hypertension

Correct Answers: A, C, E

Rationale:

• A & E: Fluid retention and decreased GFR lead to edema (often starting in the face/eyes) and high blood pressure.

• C: Hematuria causes the smoky or cola-colored appearance due to red blood cell casts.

• D is more characteristic of Nephritic syndrome; while GN has proteinuria, it is usually mild to moderate. B is incorrect as patients are typically hypertensive.

What is the primary pathophysiology of Post-Streptococcal Glomerulonephritis?

• A. Bacterial invasion of the glomerular capillaries
• B. Deposition of immune complexes in the glomerular basement membrane
• C. Primary viral infection of the nephrons
• D. Dehydration leading to tubular necrosis

Correct Answer: B

Rationale: It is a Type III hypersensitivity reaction where antigen-antibody complexes from a previous Streptococcal infection (Group A Beta-hemolytic) deposit in the kidneys, triggering inflammation.

A client is suspected of having Acute Glomerulonephritis. Which diagnostic lab result most strongly confirms a recent streptococcal infection?

• A. Elevated Blood Urea Nitrogen (BUN)
• B. Elevated Antistreptolysin O (ASO) titer
• C. Decreased Serum Creatinine
• D. Positive urine culture for E. coli

Correct Answer: B

Rationale: An elevated ASO titer indicates the body has recently produced antibodies against streptococcal toxins, supporting the diagnosis of post-streptococcal GN.

Which complications should the nurse prioritize for a patient with Glomerulonephritis? (Select all that apply)

• A. Hypertensive encephalopathy
• B. Congestive heart failure (CHF)
• C. Hypokalemia
• D. Pulmonary edema
• E. Acute Kidney Injury (AKI)

Correct Answers: A, B, D, E

Rationale: Fluid overload leads to CHF and pulmonary edema. Severe hypertension can cause encephalopathy. The inflammatory process can lead to a sudden drop in GFR (AKI). C is incorrect because renal failure usually leads to Hyperkalemia.

Which dietary instructions are appropriate for a client with Glomerulonephritis and azotemia? (Select all that apply)

• A. Sodium restriction
• B. High-protein diet
• C. Fluid restriction
• D. Potassium restriction
• E. Low-protein diet

Correct Answers: A, C, D, E

Rationale: Sodium and fluid are restricted to manage edema/hypertension. Potassium is restricted to prevent cardiac arrhythmias if output is low. Protein is restricted if azotemia (BUN elevation) is present to reduce nitrogenous waste.

Which assessment finding indicates that a patient with Glomerulonephritis is improving?

• A. Increased weight gain
• B. Increased urinary output
• C. Persistent periorbital edema
• D. Rising blood pressure

Correct Answer: B

Rationale: Diuresis (increased urine output) is usually the first sign of renal recovery and a decrease in glomerular inflammation.

What is the purpose of administering Loop Diuretics in Glomerulonephritis?

• A. To treat the underlying streptococcal infection
• B. To reduce fluid overload and blood pressure
• C. To acidify the urine
• D. To prevent the formation of renal calculi

Correct Answer: B

Rationale: Diuretics like Furosemide help the kidneys excrete excess salt and water, reducing edema and lowering blood pressure.

The nurse is educating a parent whose child has Acute Glomerulonephritis. What is the most important instruction regarding activity?

• A. Encourage vigorous exercise to improve circulation
• B. Maintain bed rest during the acute phase
• C. Child can return to contact sports immediately
• D. Avoid all movement for two weeks

Correct Answer: B

Rationale: Bed rest is encouraged during the acute phase to reduce metabolic waste production and decrease the workload on the kidneys.

Chronic Glomerulonephritis can lead to which end-stage condition?

• A. Diabetes Insipidus
• B. Nephrolithiasis
• C. End-Stage Renal Disease (ESRD)
• D. Polycystic Kidney Disease

Correct Answer: C

Rationale: Chronic inflammation leads to scarring (sclerosis) of the glomeruli over years, eventually causing irreversible kidney failure (ESRD).

Which lab finding is typically decreased in Acute Post-Streptococcal Glomerulonephritis?

• A. Serum Creatinine
• B. Serum Complement (C3) levels
• C. Blood Urea Nitrogen (BUN)
• D. Urine Specific Gravity

Correct Answer: B

Rationale: Complement levels are often low in APSGN because they are consumed during the immune-complex mediated inflammatory process.

Which symptoms suggest Hypertensive Encephalopathy in a GN patient? (Select all that apply)

• A. Headache
• B. Visual disturbances
• C. Seizures
• D. Bradycardia
• E. Altered mental status

Correct Answers: A, B, C, E

Rationale: Rapidly rising blood pressure from GN causes cerebral edema, manifesting as neuro-irritability, headaches, changes in vision, and potential seizures.

How long after a throat or skin infection does Acute Post-Streptococcal Glomerulonephritis typically appear?

• A. 24 to 48 hours
• B. 1 to 3 weeks
• C. 2 to 3 months
• D. Immediately after the fever breaks

Correct Answer: B

Rationale: There is a latent period of approximately 1 to 2 weeks after pharyngitis and up to 3 weeks after skin infections (impetigo) before renal symptoms manifest.

Which of the following is a key medication used to control high blood pressure in Glomerulonephritis?

• A. Aminoglycosides
• B. Calcium Channel Blockers
• C. Morphine
• D. NSAIDs

Correct Answer: B

Rationale: Antihypertensives like Calcium Channel Blockers or ACE inhibitors are used. D is contraindicated as NSAIDs can further decrease renal blood flow.

A nurse is assessing a patient with Glomerulonephritis. Which finding indicates fluid volume excess? (Select all that apply)

• A. Distended neck veins
• B. Crackles in the lungs
• C. Flattened neck veins
• D. Weight loss
• E. S3 heart sound

Correct Answers: A, B, E

Rationale: Distended neck veins, bibasilar crackles, and an S3 gallop are classic indicators of fluid overload and potential heart failure.

Which diagnostic procedure is the definitive method for diagnosing the specific type of Glomerulonephritis?

• A. Renal Ultrasound
• B. KUB X-ray
• C. Renal Biopsy
• D. Voiding Cystourethrogram

Correct Answer: C

Rationale: While labs provide clues, a renal biopsy provides a tissue sample to identify the specific pattern of glomerular damage.

What is the characteristic appearance of Red Blood Cells (RBCs) in the urine of a patient with GN?

• A. Normal, biconcave shapes
• B. Erythrocyte casts and dysmorphic RBCs
• C. Large, clotted segments
• D. White blood cell casts

Correct Answer: B

Rationale: In GN, RBCs are forced through damaged glomerular membranes, distorting their shape (dysmorphic) and forming casts in the tubules.

Which patient statement indicates a need for further education regarding Glomerulonephritis?

• A. 'I will weigh myself every morning.'
• B. 'I should stop taking my blood pressure pills once my urine looks clear.'
• C. 'I need to limit the amount of salt I add to my food.'
• D. 'I will report any sudden shortness of breath to my doctor.'

Correct Answer: B

Rationale: Patients must complete the medication course and follow up even if symptoms seem to have subsided to prevent relapse or chronic damage.

In Glomerulonephritis, why does the urine protein level rise?

• A. The bladder is infected
• B. Increased permeability of the glomerular capillary membrane
• C. The patient is eating too much protein
• D. Decrease in renal tubular reabsorption

Correct Answer: B

Rationale: Inflammation damages the filtration 'slits' in the glomerulus, allowing larger molecules like proteins (albumin) to leak out.

Which nursing intervention is most effective for monitoring fluid status in a patient with GN?

• A. Measuring abdominal girth once a week
• B. Daily weights at the same time with the same scale
• C. Checking skin turgor every hour
• D. Monitoring heart rate every 8 hours

Correct Answer: B

Rationale: Daily weights are the most accurate and sensitive non-invasive indicator of fluid volume changes.

What is common in the medical history of a patient diagnosed with GN?

• A. Recent travel to a tropical country
• B. Recent sore throat or skin infection
• C. History of kidney stones
• D. Recent high-protein diet

Correct Answer: B

Rationale: APSGN often follows an upper respiratory infection or a skin infection like impetigo causing a 'stray' immune response.

What is the primary goal of treatment during the acute phase of GN?

• A. Increase the glomerular filtration rate (GFR) to double normal levels
• B. Protect the kidneys from further damage and manage symptoms
• C. Rapidly hydrate the patient with IV fluids
• D. Increase physical mobility

Correct Answer: B

Rationale: Management focuses on controlling hypertension, edema, and nitrogenous waste while the inflammation resolves.

Which of the following would be an expected finding in a urinalysis for a patient with GN?

• A. Glucose
• B. Casts
• C. Ketones
• D. Nitrites

Correct Answer: B

Rationale: Protein and red blood cell casts are 'footprints' of glomerular inflammation and damage.

A patient with GN has a sudden decrease in urine output to 100\text{ mL} in 24 hours. How is this categorized?

• A. Polyuria
• B. Dysuria
• C. Oliguria
• D. Anuria

Correct Answer: C

Rationale: Oliguria is defined as urine output less than 400\text{ mL} per day in adults. (Anuria is less than 50 to 100\text{ mL}).

True or False: Antibiotics are given in GN to heal the damaged glomeruli.

Answer: False

Rationale: Antibiotics are given only to eliminate any remaining streptococcal bacteria (the source) but have no direct effect on the immune complexes already in the glomeruli.

A child with GN presents with a headache and blurred vision. What should the nurse do first?

• A. Administer acetaminophen for the headache
• B. Assess the blood pressure
• C. Check the child's pupillary response
• D. Encourage the child to sleep

Correct Answer: B

Rationale: These are warning signs of hypertensive encephalopathy; blood pressure assessment is critical to determine the severity.

Which electrolytes are most likely to be elevated in the blood of a GN patient? (Select all that apply)

• A. Potassium
• B. Sodium (dilutional can occur, but retention is common)
• C. Phosphate
• D. Calcium
• E. Magnesium

Correct Answers: A, C

Rationale: As kidney function fails, the ability to excrete Potassium and Phosphate decreases. Calcium often decreases in inverse proportion to Phosphate.

Why is the skin often itchy (pruritus) in patients with chronic GN?

• A. Allergic reaction to antibiotics
• B. Accumulation of urea and waste products (Uremic Frost)
• C. Excessive use of soap
• D. Decreased blood flow to the skin

Correct Answer: B

Rationale: Uremia (high levels of urea and other toxins in the blood) leads to waste being excreted through the sweat, causing itching.

A nurse is checking the lab results for a patient with GN. The Blood Urea Nitrogen (BUN) is elevated. This indicates:

• A. The client is dehydrated
• B. The kidneys are not filtering nitrogenous waste effectively
• C. The liver is overproducing urea
• D. The client is consuming too many fluids

Correct Answer: B

Rationale: BUN rises when the glomerular filtration rate decreases, resulting in the buildup of breakdown products of protein metabolism.

Nephritic syndrome (associated with GN) is primarily characterized by which triad?

• A. Hematuria, Hypertension, and Oliguria
• B. Hypotension, Edema, and Tachycardia
• C. Hyperglycemia, Hematuria, and Weight loss
• D. Anuria, Fever, and Flank pain

Correct Answer: A

Rationale: The 'Nephritic' signs result from the inflammatory clogging of the glomeruli.

When educating a patient on fluid restriction, what is the 'insensible loss' usually estimated at?

• A. 100\text{ mL}
• B. 500\text{ mL} to 600\text{ mL}
• C. 1000\text{ mL}
• D. 2000\text{ mL}

Correct Answer: B

Rationale: Fluid restriction is often calculated as 'previous day's urine output + 500 to 600\text{ mL}' (covering loss from sweat and respiration).

What is the priority nursing diagnosis for a patient with GN who has crackles and a weight gain of 5\text{ lbs} in 2 days?

• A. Risk for infection
• B. Fluid Volume Excess
• C. Impaired Skin Integrity
• D. Knowledge Deficit

Correct Answer: B

Rationale: The physical signs (crackles, weight gain) indicate a critical imbalance in fluid volume exceeding the body's compensations.

A patient with GN should be taught to avoid which over-the-counter medications due to nephrotoxicity?

• A. Acetaminophen
• B. NSAIDs (e.g., Ibuprofen, Naproxen)
• C. Antacids containing aluminum
• D. Vitamin C

Correct Answer: B

Rationale: NSAIDs inhibit prostaglandins that maintain renal blood flow, which can exacerbate renal failure in GN.

In GN, what is the physiological reason for Periorbital Edema?

• A. Gravity pulling fluid to the face
• B. Low pressure in the facial tissues allowing fluid to accumulate during sleep
• C. Increased intracranial pressure
• D. Infection of the eyes

Correct Answer: B

Rationale: Because facial tissues have low tissue pressure, fluid easily collects there, especially in the morning after being recumbent.

Which of the following is an early sign of Acute Kidney Injury in a client with GN?

• A. Severe flank pain
• B. Sudden drop in urine output
• C. High fever
• D. Jaundice

Correct Answer: B

Rationale: Oliguria is the most common early indicator of declining glomerular filtration.

What is the effect of GN on Serum Albumin levels?

• A. They increase significantly
• B. They stay the same
• C. They decrease (Hypoalbuminemia)
• D. Only the globulin levels change

Correct Answer: C

Rationale: Loss of albumin through the damaged glomerular membrane into the urine lowers the level of albumin in the blood.

During the recovery phase of GN, what usually happens to the urine?

• A. It becomes very dark
• B. It becomes clear and increases in volume
• C. It stops completely
• D. It becomes thick with mucus

Correct Answer: B

Rationale: As inflammation subsides, the kidneys regain filtration capacity, leading to diuresis and clearing of blood/protein.

Corticosteroids may be used in certain types of GN to:

• A. Kill the bacteria
• B. Suppress the inflammatory/immune response
• C. Increase urine output
• D. Lower blood glucose

Correct Answer: B

Rationale: Steroids like Prednisone reduce the immune activity attacking the glomerular basement membrane.

Which finding should be reported to the provider immediately for a GN patient?

• A. Urine output of 30\text{ mL}/\text{hr}
• B. Weight gain of 2\text{ kg} in one day
• C. A mild headache
• D. $1+$ pitting edema

Correct Answer: B

Rationale: Significant weight gain (2\text{ kg} = 4.4\text{ lbs}) suggests rapid fluid retention that could lead to heart failure or pulmonary edema.

A child with GN is in the playroom. Which activity is most appropriate?

• A. Tugging-of-war
• B. Jumping on a trampoline
• C. Sitting and coloring
• D. Playing tag

Correct Answer: C

Rationale: During the acute phase, quiet, low-energy activities are preferred to maintain bed rest/restricted activity protocol.

Which of the following is NOT a common cause of Glomerulonephritis?

• A. Systemic Lupus Erythematosus (SLE)
• B. Group A Strep
• C. Goodpasture Syndrome
• D. Chronic Urinary Tract Infection (UTI)

Correct Answer: D

Rationale: UTIs usually affect the lower urinary tract or renal pelvis (Pyelonephritis), whereas GN is an autoimmune/inflammatory process of the glomeruli.

What change in the 'Specific Gravity' of urine is expected in the acute phase of GN?

• A. Fixed at 1.010
• B. Low (< 1.005)
• C. Elevated (> 1.025)
• D. Zero

Correct Answer: C

Rationale: The urine is typically concentrated (low volume, high solute) in the early stages, unless the kidneys have reached a state of 'fixed' gravity due to severe damage.

Which assessment is most important for a patient receiving IV Furosemide for GN-related edema?

• A. Monitoring hearing (Ototoxicity)
• B. Monitoring Blood Pressure
• C. Assessing for skin rashes
• D. Checking bowel sounds

Correct Answer: B

Rationale: While ototoxicity is a risk, Furosemide is given to lower BP and resolve fluid overload; rapid shifts in BP must be monitored.

Which is an expected outcome for a patient with GN?

• A. Hematocrit of 25\%,
• B. Absence of adventitious breath sounds
• C. Blood pressure of 160/110
• D. Weight gain of 3\text{ lbs} per week

Correct Answer: B

Rationale: Clear breath sounds indicate that the patient is not in pulmonary edema, a primary goal of fluid management.

Azotemia in GN is defined as:

• A. Excessive sugar in the urine
• B. Accumulation of nitrogenous waste in the blood
• C. Low potassium in the blood
• D. High levels of white blood cells in the urine

Correct Answer: B

Rationale: Azotemia refers to the elevation of BUN and Creatinine.

What is the rationale for restricting sodium in a patient with GN?

• A. Sodium causes the urine to turn dark
• B. Sodium attracts water, worsening edema and hypertension
• C. Sodium destroys the glomerular membrane
• D. Sodium interferes with antibiotic absorption

Correct Answer: B

Rationale: Water follows sodium; excessive sodium intake expands the extracellular fluid volume.

Which type of diet is usually recommended for a child with recovery-phase GN and no signs of failure?

• A. Regular diet with no added salt
• B. High calorie, high protein
• C. Fluid restriction to 200\text{ mL}/\text{day}
• D. NPO status

Correct Answer: A

Rationale: Once recovery begins (diuresis, normal BP), the diet can transition to regular, though salt is still often moderated.

What should the nurse monitor for in a patient with GN who is also taking Digoxin for heart failure?

• A. Signs of Digoxin toxicity due to decreased renal clearance
• B. Increased effect of antibiotics
• C. Decreased blood pressure
• D. Iron deficiency

Correct Answer: A

Rationale: Digoxin is excreted by the kidneys. If GN has markedly reduced GFR, Digoxin can build up to toxic levels.

True or False: Most children with APSGN recover completely without permanent damage.

Answer: True

Rationale: Over 95\% of children with Acute Post-Streptococcal GN recover fully with conservative management.

Which sign indicates that GN is progressing to Chronic Glomerulonephritis?

• A. Sudden resolution of all symptoms
• B. Persistent proteinuria and hematuria over months/years
• C. A single negative ASO titer
• D. Occasional headaches

Correct Answer: B

Rationale: Ongoing presence of protein or blood in the urine indicates the inflammatory process has not resolved and is causing permanent damage.

Which test is used to monitor the effectiveness of protein restriction in a GN patient?

• A. Serum Creatinine
• B. Blood Urea Nitrogen (BUN)
• C. Hemoglobin A1c
• D. Urine Culture

Correct Answer: B

Rationale: BUN is a direct byproduct of protein metabolism; if it stays very high, protein intake usually needs further reduction.

In Glomerulonephritis, why might a patient develop anemia?

• A. Loss of blood in the urine and decreased Erythropoietin production
• B. High sodium levels destroying RBCs
• C. Lack of Vitamin K
• D. Excessive water intake diluting the blood

Correct Answer: A

Rationale: Hematuria causes 'chronic' blood loss, and diseased kidneys produce less Erythropoietin, the hormone needed for RBC production.

Which of the following is a symptom of Pulmonary Edema, a complication of GN?

• A. Dry cough and bradycardia
• B. Pink, frothy sputum and dyspnea
• C. Sharp chest pain on inspiration
• D. Increased urine output

Correct Answer: B

Rationale: Fluid in the alveoli presents as shortness of breath and classic pink-tinged frothy sputum.

A nurse is assessing a male client with GN. He has significant scrotal edema. What is the priority nursing intervention?

• A. Apply heat to the area
• B. Provide a scrotal support (sling) and elevate
• C. Encourage the client to walk more
• D. Limit all intake of protein

Correct Answer: B

Rationale: Elevation and support help reduce edema in dependent areas and improve comfort.

A patient with GN asks why their urine is so 'cloudy.' The nurse explains this is due to:

• A. Sugar in the urine
• B. The presence of protein and sediment (casts/cells)
• C. Not drinking enough orange juice
• D. Use of diuretics

Correct Answer: B

Rationale: Increased protein and the presence of casts/RBCs change the clarity and color of the urine.

Which of the following are nursing priorities for GN? (Select all that apply)

• A. Fluid volume management
• B. Skin integrity for edematous areas
• C. Promoting high-intensity exercise
• D. Monitoring for neurological changes
• E. Balancing rest and activity

Correct Answers: A, B, D, E

Rationale: Fluid balance is #1. Skin is fragile