A nurse is caring for a client who reports to the clinic for laboratory tests. The client has an acute injury caused by acute tubular necrosis and asks why their glomerular filtration rate keeps decreasing. Which of the following pathophysiological changes occurring in the kidney should the nurse explain as the cause of decrease?
The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys.
The glomerular filtration rate decreases because there is injury to the renal tubular cells.
The glomerular filtration rate decreases because inflammatory dells invade the already damaged kidneys.
The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down.
The Correct Answer is B
A. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys. Reduced blood flow to the kidneys, or renal hypoperfusion, decreases the glomerular filtration rate (GFR) because less blood is being filtered through the kidneys. This can occur in conditions such as shock, severe dehydration, or heart failure, but it is not the primary mechanism in acute tubular necrosis (ATN).
B. The glomerular filtration rate decreases because there is injury to the renal tubular cells. In ATN, the injury to renal tubular cells impairs their function, leading to reduced reabsorption and filtration ability, which contributes to the decrease in GFR.
C. The glomerular filtration rate decreases because inflammatory cells invade the already damaged kidneys. While inflammation may be present, it is not the primary cause of decreased GFR in acute tubular necrosis; reduced blood flow and tubular cell injury are more direct causes.
D. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down. Obstruction is not typically a characteristic of acute tubular necrosis; ATN is usually caused by ischemic or toxic injury, not physical obstruction.
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Correct Answer is C
Explanation
A. Influenza: Influenza typically presents with a high fever, muscle aches, and fatigue, which are not present in this case.
B. Strep Throat: Strep throat usually presents with a sore throat, high fever, and swollen lymph nodes, not nasal congestion or watery eyes.
C. Rhinitis: Rhinitis, particularly allergic rhinitis, causes symptoms such as sneezing, nasal congestion, watery eyes, and malaise without fever, making it the most likely diagnosis.
D. Bacterial Pharyngitis: Bacterial pharyngitis often presents with a sore throat, fever, and swollen lymph nodes, but typically does not include nasal congestion or watery eyes.
Correct Answer is ["B","C","D"]
Explanation
A. Obese extremities. Clients with Cushing's syndrome typically experience central (truncal) obesity with thin extremities due to fat redistribution and muscle wasting, not obese extremities.
B. Buffalo hump: A "buffalo hump" (fat pad on the back of the neck) is a common characteristic of Cushing's syndrome due to abnormal fat distribution.
C. Purple striations. Purple or reddish striae on the abdomen and other areas are commonly seen in Cushing's syndrome due to skin thinning and collagen breakdown.
D. Moon face. A round, full face (moon face) is a classic sign of Cushing's syndrome due to fat deposits in the face.
E. Tremors. Tremors are not typically associated with Cushing's syndrome and are more often associated with neurological or metabolic conditions.