Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
Which client is at greatest risk of acute intra-renal kidney injury?
A. A 54-year-old male with bladder cancer
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.
B. A 65-year-old male with benign prostatic hyperplasia
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.
C. A 25-year-old female receiving chemotherapy for cancer
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.
D. A 36-year-old female with renal artery stenosis
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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Full Explanation
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.
Similar Questions
Which statement about Crohn’s disease is accurate?
A. Crohn’s disease always spreads to the liver
Crohn’s disease does not always spread to the liver. While it can cause liver complications like primary sclerosing cholangitis or fatty liver in some cases, this is not universal. This statement is inaccurate, as liver involvement is a complication, not a defining feature of Crohn’s disease.
B. There is a patchy pattern of bowel tissue involvement
Crohn’s disease is characterized by a patchy, or “skip lesion,” pattern of bowel involvement, affecting any part of the gastrointestinal tract discontinuously. Inflammation is transmural, causing fistulas or strictures. This statement is accurate, as the patchy distribution is a hallmark distinguishing it from ulcerative colitis.
C. There is a continuous pattern of tissue involvement
Continuous bowel involvement is characteristic of ulcerative colitis, not Crohn’s disease. Crohn’s affects the bowel in a segmental, patchy manner, with healthy areas between lesions. This statement is inaccurate, as it incorrectly describes Crohn’s tissue involvement pattern, which is distinctly non-continuous.
D. Increases the risk of strokes in some clients
Crohn’s disease increases cardiovascular risk due to chronic inflammation, but stroke is not a well-established direct complication. Inflammatory markers may contribute to atherosclerosis, but stroke risk is less specific than patchy bowel involvement. This statement is inaccurate, as it overstates a specific stroke association.
Full Explanation
Choice A reason: Crohn’s disease does not always spread to the liver. While it can cause liver complications like primary sclerosing cholangitis or fatty liver in some cases, this is not universal. This statement is inaccurate, as liver involvement is a complication, not a defining feature of Crohn’s disease.
Choice B reason: Crohn’s disease is characterized by a patchy, or “skip lesion,” pattern of bowel involvement, affecting any part of the gastrointestinal tract discontinuously. Inflammation is transmural, causing fistulas or strictures. This statement is accurate, as the patchy distribution is a hallmark distinguishing it from ulcerative colitis.
Choice C reason: Continuous bowel involvement is characteristic of ulcerative colitis, not Crohn’s disease. Crohn’s affects the bowel in a segmental, patchy manner, with healthy areas between lesions. This statement is inaccurate, as it incorrectly describes Crohn’s tissue involvement pattern, which is distinctly non-continuous.
Choice D reason: Crohn’s disease increases cardiovascular risk due to chronic inflammation, but stroke is not a well-established direct complication. Inflammatory markers may contribute to atherosclerosis, but stroke risk is less specific than patchy bowel involvement. This statement is inaccurate, as it overstates a specific stroke association.
The client has been ordered allopurinol (Zyloprim) and is preparing for discharge. What should the nurse include in the discharge instructions?
A. This medication will target the inflammation and pain during an acute attack
Allopurinol does not directly target inflammation or pain in acute gout attacks; it lowers uric acid levels to prevent future attacks. Anti-inflammatories like NSAIDs or colchicine manage acute symptoms. This statement is inaccurate, as allopurinol’s role is preventive, not for acute symptom relief.
B. This medication decreases the production of uric acid
Allopurinol inhibits xanthine oxidase, reducing uric acid production, which prevents urate crystal formation and gout attacks. It is used for long-term management of hyperuricemia. This statement is accurate, as decreased uric acid production is the primary mechanism, critical for patient education on its purpose.
C. Kidney function tests are not necessary when using this medication
Kidney function tests are necessary with allopurinol, as it is renally excreted, and impaired renal function can increase toxicity risk (e.g., rash, interstitial nephritis). Monitoring ensures safe use, especially in gout patients with potential renal issues, making this statement inaccurate for discharge instructions.
D. Limit fluid intake to 1000cc per day to prevent urinary incontinence
Limiting fluid intake to 1000cc daily is inappropriate; high fluid intake (2-3L/day) is recommended with allopurinol to prevent urate kidney stones by diluting urine. This statement is inaccurate, as it contradicts the need for hydration to support uric acid excretion and prevent complications.
Full Explanation
Choice A reason: Allopurinol does not directly target inflammation or pain in acute gout attacks; it lowers uric acid levels to prevent future attacks. Anti-inflammatories like NSAIDs or colchicine manage acute symptoms. This statement is inaccurate, as allopurinol’s role is preventive, not for acute symptom relief.
Choice B reason: Allopurinol inhibits xanthine oxidase, reducing uric acid production, which prevents urate crystal formation and gout attacks. It is used for long-term management of hyperuricemia. This statement is accurate, as decreased uric acid production is the primary mechanism, critical for patient education on its purpose.
Choice C reason: Kidney function tests are necessary with allopurinol, as it is renally excreted, and impaired renal function can increase toxicity risk (e.g., rash, interstitial nephritis). Monitoring ensures safe use, especially in gout patients with potential renal issues, making this statement inaccurate for discharge instructions.
Choice D reason: Limiting fluid intake to 1000cc daily is inappropriate; high fluid intake (2-3L/day) is recommended with allopurinol to prevent urate kidney stones by diluting urine. This statement is inaccurate, as it contradicts the need for hydration to support uric acid excretion and prevent complications.
The nurse is caring for a client who reports periods of exacerbations and remissions of bloody diarrhea and abdominal pain. A recent X-ray indicated a continuous pattern of lesions in the large bowel. What underlying condition does the nurse suspect?
A. Colorectal cancer
Colorectal cancer may cause bleeding or pain but typically presents with mass lesions or obstruction, not a continuous pattern of mucosal lesions on X-ray. Its symptoms are less likely to remit and exacerbate cyclically, unlike inflammatory bowel diseases, making it less likely than ulcerative colitis.
B. Crohn’s disease
Crohn’s disease causes patchy, transmural bowel lesions, not continuous large bowel involvement. Its skip lesions and potential for small bowel involvement distinguish it from the continuous mucosal inflammation seen in ulcerative colitis, making this an inaccurate diagnosis for the described X-ray findings.
C. Diverticulitis
Diverticulitis involves inflamed diverticula, typically causing localized pain and fever, not continuous large bowel lesions or bloody diarrhea with remissions. X-ray may show diverticula, but not diffuse mucosal involvement. This condition is less likely than ulcerative colitis given the described symptom pattern.
D. Ulcerative colitis
Ulcerative colitis causes continuous mucosal inflammation in the large bowel, leading to bloody diarrhea, abdominal pain, and periods of exacerbation and remission. X-ray showing continuous lesions aligns with its diffuse colitis pattern, making this the most accurate diagnosis for the client’s symptoms and findings.
Full Explanation
Choice A reason: Colorectal cancer may cause bleeding or pain but typically presents with mass lesions or obstruction, not a continuous pattern of mucosal lesions on X-ray. Its symptoms are less likely to remit and exacerbate cyclically, unlike inflammatory bowel diseases, making it less likely than ulcerative colitis.
Choice B reason: Crohn’s disease causes patchy, transmural bowel lesions, not continuous large bowel involvement. Its skip lesions and potential for small bowel involvement distinguish it from the continuous mucosal inflammation seen in ulcerative colitis, making this an inaccurate diagnosis for the described X-ray findings.
Choice C reason: Diverticulitis involves inflamed diverticula, typically causing localized pain and fever, not continuous large bowel lesions or bloody diarrhea with remissions. X-ray may show diverticula, but not diffuse mucosal involvement. This condition is less likely than ulcerative colitis given the described symptom pattern.
Choice D reason: Ulcerative colitis causes continuous mucosal inflammation in the large bowel, leading to bloody diarrhea, abdominal pain, and periods of exacerbation and remission. X-ray showing continuous lesions aligns with its diffuse colitis pattern, making this the most accurate diagnosis for the client’s symptoms and findings.