Deck 28: Kidney Diseases

Question 1

Nutrition therapy for the nephrotic syndrome focuses on ____.

A) increasing the fat content in the diet
B) preventing protein-energy malnutrition and alleviating edema
C) high protein and kcalorie intake
D) high sodium intake

Answer 1

B

Question 2

A consequence of the nephrotic syndrome is the loss of plasma proteins in the urine, which contributes to ____.

A) an increased risk of blood clotting
B) a fluid shift from interstitial spaces to blood plasma
C) an increased risk of vitamin D toxicity
D) Anabolic buildup of muscle mass

Answer 2

A

Question 3

What is the most abundant plasma protein?

A) albumin
B) immunoglobulins
C) vitamin D-binding protein
D) transferrin

Answer 3

A

Question 4

Diets high in vitamin D and calcium are recommended for children with nephrotic syndrome to prevent ____.

A) beriberi
B) marasmus
C) nephrosclerosis
D) rickets

Question 5

What best describes the function of the ureter?

A) storing urine before it is excreted
B) Conducting urine from the kidneys to the bladder
C) transporting urine from the bladder to out side of the body
D) carrying blood from the kidneys back to the heart

Question 6

For patients with nephrotic syndrome, the recommended daily protein intake is ____ g/kg of body weight.

A) 0.4 to 0.6
B) 0.6 to 0.8
C) 0.8 to 1.0
D) 1.0 to 1.2

Question 7

In the nephrotic syndrome, urinary protein losses generally average about ____ grams daily.

A) 3 to 3.5
B) 5.5 to 6
C) 9 to 10.5
D) 11 to 12

Question 8

Proteinuria due to nephrotic syndrome results in a loss of immunoglobulins, which increases the risk for ____.

A) edema
B) infection
C) wasting
D) hypertriglyceridemia

Question 9

In patients with the nephrotic syndrome, energy intake of about ____ kcal/kg of body weight daily will sustain weight and spare protein.

A) 15
B) 25
C) 35
D) 45

Question 10

Daily sodium intake should be restricted to about ____ grams for patients with the nephrotic syndrome.

A) 0.5 to 1.0
B) 1.0 to 2.0
C) 2.0 to 3.0
D) 3.0 to 4.0

Question 11

One large egg contains about ____ mg of sodium.

A) 10
B) 40
C) 60
D) 200

Question 12

What hormone secreted by the kidneys stimulates the production of red blood cells?

A) erythropoietin
B) renin
C) aldosterone
D) vasopressin

Question 13

Patients with the nephrotic syndrome may benefit from calcium supplementation of ____ mg daily.

A) 500 to 1000
B) 1000 to 1500
C) 1500 to 2000
D) 2000 to 2500

Question 14

To regulate blood pressure, the kidneys secrete ____.

A) aldosterone
B) erythropoietin
C) renin
D) vasopressin

Question 15

A high-protein diet for a client with the nephrotic syndrome is contraindicated because ____.

A) protein foods are usually high in fat
B) energy requirements are decreased with nephrotic syndrome
C) high protein intakes may exacerbate urinary protein losses and further damage the kidney
D) protein levels in nephrotic syndrome are not altered

Question 16

The cuplike component of the nephron that surrounds the glomerulus and collects the filtrate is called "____."

A) Bowman's capsule
B) the ureter
C) the collecting duct
D) the tubule

Question 17

Daniel is a 10-year-old boy who has just been diagnosed with the nephrotic syndrome. Which condition might he develop as a result?

A) beriberi
B) pellagra
C) anemia
D) rickets

Question 18

In the nephrotic syndrome, the kidney's ability to excrete ____ is impaired, contributing to edema.

A) potassium
B) sodium
C) renin
D) calcium

Question 19

Billy Lewis is a 20-year-old man admitted to the hospital with the nephrotic syndrome. He is 5 ft 11 in., weighs 192 lb, and has edema. His blood values include albumin 1.7 g/dL, K ⁺ 3.3 mEq/L, and LDL cholesterol 192 mg/dL. He says he is hungry and wants a snack. The most appropriate food choice is ____.

A) a sausage biscuit
B) a grilled chicken sandwich with lettuce and tomato
C) peanut butter and crackers
D) cottage cheese and canned fruit

Question 20

The nephrotic syndrome is associated with accelerated atherosclerosis and a sharply increased risk of heart disease and ____.

A) liver disease
B) stomach cancer
C) stroke
D) hypertension

Question 21

A patient whose height is 5 ft 9 in. and weight 185 lb is admitted to the hospital with acute kidney injury and is started on hemodialysis. What would be the recommended protein intake (in grams) for this patient?

A) 40 to 65
B) 60 to 82
C) 84 to 143
D) 150 to 165

Question 22

A glomerular filtration rate (GFR) of ____ mL/min is characteristic of kidney failure.

A)
B) 15 to 29
C) 30 to 59
D) 60 to 89

Question 23

A type of skin change that develops due to uremia from chronic kidney disease is ____.

A) maceration
B) pruritus
C) hives
D) diaphoresis

Question 24

Diabetes mellitus causes about ____ of chronic kidney disease cases in the United States.

A) 35%
B) 45%
C) 55%
D) 65%

Question 25

Hyperkalemia occurs when there is excessive ____ in the blood.

A) calcium
B) potassium
C) phosphorus
D) vitamin D

Question 26

What is a prerenal cause of acute kidney injury?

A) heart failure
B) sickle cell disease
C) diabetes mellitus
D) pregnancy

Question 27

Which condition often develops as a result of increased secretion of parathyroid hormone in patients with chronic kidney disease?

A) fatty liver disease
B) gastroesophageal reflux
C) dumping syndrome
D) bone loss

Question 28

The glucose absorbed from the dialysate used in peritoneal dialysis can provide as many as ____ kcalories daily.

A) 200
B) 400
C) 600
D) 1000

Question 29

In the nephrotic syndrome, the liver attempts to compensate for the loss in protein by ____.

A) decreasing its synthesis of various plasma proteins
B) decreasing glomerular permeability
C) increasing albumin levels
D) increasing its synthesis of various plasma proteins

Question 30

What is the percentage of sodium that comes from processed foods, unprocessed natural foods, and table salt respectively?

A) 50, 40, 10
B) 75, 10, 15
C) 90, 5, 5
D) 90, 0, 10

Question 31

In patients with reduced urine production, recovery from acute kidney injury begins with a period of ____, in which large amounts of fluid are excreted.

A) catabolism
B) uremia
C) diuresis
D) oliguria

Question 32

Edema that develops with acute kidney injury is most often treated with which type of medication?

A) potassium-exchange resins
B) phosphate binders
C) diuretics
D) insulin

Question 33

Normal urine volume is approximately ____ mL per day.

A) 500 to 1000
B) 1000 to 1500
C) 1500 to 2000
D) 2000 to 2500

Question 34

The rate at which filtrate is formed within the kidney is normally about ____ mL/min in healthy adults.

A) 15
B) 60
C) 100
D) 125

Question 35

What is an intrarenal cause of acute kidney injury?

A) food poisoning due to Escherichia coli
B) pregnancy
C) blood clots
D) bladder rupture

Question 36

Acute kidney injury is characterized by reduced urine output coupled with a progressive rise in serum ___ levels.

A) ammonia
B) creatinine
C) amino acids
D) lipids

Question 37

What is considered to be the best index of overall kidney function?

A) glomerular filtration rate
B) albumin levels
C) anemia
D) renal osteodystrophy

Question 38

What is a postrenal cause of acute kidney injury?

A) infection
B) nephrotoxic drugs
C) pregnancy
D) heart attack

Question 39

The removal of excess fluids and wastes from the blood using the peritoneum as a semipermeable membrane is called "____."

A) chronic dialysis
B) hemodialysis
C) peritoneal dialysis
D) acute dialysis

Question 40

Why might patients with the nephrotic syndrome be advised to eat foods that are high in potassium?

A) Treatment with certain diuretics results in potassium loss.
B) Protein loss is typically accompanied by potassium loss.
C) They are unable to properly absorb potassium.
D) To reduce bone loss associated with low serum potassium.

Question 41

Which item is a high-potassium food?

A) honeydew melon
B) watermelon
C) avocado
D) blueberries

Question 42

Which item contributes to high uric acid levels?

A) oxalate
B) purines
C) cystine
D) magnesium

Question 43

The movement of solutes from an area of high concentration to one of low concentration is known as ____.

A) osmosis
B) diffusion
C) permeability
D) oncotic pressure

Question 44

Which interaction is associated with the use of immunosuppressants?

A) Alcohol intake has the potential for toxic effects.
B) Bioavailability of medication is increased when the drug is taken with food.
C) Grapefruit juice can dangerously decrease serum concentrations of the medication.
D) Calcium and magnesium supplements must be taken separately.

Question 45

Intradialytic parenteral nutrition ____.

A) combines parenteral nutrition with hemodialysis
B) substitutes parenteral nutrition for hemodialysis
C) substitutes hemodialysis for parenteral nutrition
D) delays the need for hemodialysis by manipulating nutrition

Question 46

The most common method used to evaluate the adequacy of dialysis treatment is ____.

A) blood urea nitrogen
B) urea kinetic modeling
C) weighing a patient predialysis and postdialysis
D) self-report of fluid intake and output

Question 47

Which food is high in phosphorus?

A) gelatin
B) apple
C) chocolate
D) fish

Question 48

Approximately ____ of patients with end-stage renal disease receive a kidney transplant.

A) 15%
B) 20%
C) 40%
D) 55%

Question 49

Struvite stones are composed mainly of ____.

A) magnesium ammonium phosphate
B) bile acid salts
C) urinary citrate
D) purines

Question 50

Prior to his kidney transplant, John Miller was on dialysis and his sodium intake was restricted to 2000 mg daily. His blood pressure levels have averaged 140/90 mmHg. When Mr. Miller inquires if he should continue to restrict his sodium after his transplant, you reply, ____.

A) "Since your renal function has been restored, you will never need to restrict your sodium intake."
B) "Since your blood pressure is still elevated, you need to restrict your sodium level to 2.0 to 2.4 g/day."
C) "Since you are going to be on diuretics, there is no need to restrict sodium."
D) "Once you are on the immunosuppressants, you will no longer need to restrict sodium intake."

Question 51

One of the most common complications associated with hemodialysis is ____.

A) hypertension
B)   blood clots
C)   hyperglycemia
D)   joint inflammation

Question 52

Morgan Simmons, a 74-year-old woman, is on hemodialysis. She wants to continue consuming 3 cups of non-fat milk per day. What is the most appropriate response?

A) "Continue consuming three cups a day; you need calcium and vitamin D."
B) "Increase your milk intake to four cups per day."
C) "Milk contains phosphorus and too much can be harmful for your medical condition."
D) "Do not drink milk at all. Take the vitamin D and calcium supplements instead."

Question 53

Which factor would most likely predispose a person to development of kidney stones?

A) urinary obstruction
B) increased urine volume
C) decreased protein intake
D) administration of immunosuppressant medications

Question 54

Supplements of folic acid prescribed for dialysis patients typically supply ____ mg daily.

A) 1
B) 5
C) 10
D) 20

Question 55

What is the most common complication of peritoneal dialysis?

A) hypoglycemia
B) infection
C) hypotension
D) hernia

Question 56

The best preventive treatment for all types of kidney stones is to ____.

A) drink plenty of fluids
B) consume a diet high in berries and juices
C) limit plant proteins
D) increase vitamin C intake

Question 57

What is an advantage of using continuous renal replacement therapy (CRRT)?

A) It does not damage arteries
B)   It does not cause sudden shifts in blood volume
C) It does not lead to blood clots.
D)   It prevents patients from developing hypotension.

Question 58

Intakes of supplemental vitamin C are restricted to 100 mg/day in patients with chronic renal failure to prevent ____.

A) kidney stones
B) scurvy
C) colds
D) hemochromatosis

Question 59

Which treatment is used to dialyze patients with acute kidney injury?

A) peritoneal dialysis
B) hemodialysis
C) continuous renal replacement therapy
D) intermittent dialysis

Question 60

What best describes renal colic?

A) urination urgency as a result of kidney stone obstruction
B) intense pain as a kidney stone passes through the ureter
C) a kidney infection that develops due to struvite kidney stones
D) crystallized urine that has backed up into the kidneys

Question 61

Charlie Which meal is most appropriate for Charlie?

A) low-fat milk, fried chicken strips, ketchup, French fries, and sliced apples
B) apple juice, shrimp fried rice, duck sauce, and spring roll
C) grape juice, canned chicken noodle soup, cheeseburger with ketchup, and fruit cup
D) low-fat milk, grilled chicken, rice pilaf, and sliced pears

Question 62

Jasmine Singh Due to her history of hypercalciuria, Jasmine most likely has ____ stones.

A) struvite
B) cystine
C) uric acid
D) calcium oxalate

Question 64

Jasmine Singh is 25 years old. She has had hypercalciuria due to elevated serum levels of parathyroid hormone over the past year. She makes an appointment with her physician after an episode of nausea, vomiting, severe pain in the groin, and pain while urinating. At her doctor's office, Jasmine provides a urine sample. Testing confirms blood in her urine. This indicates ____.

A) renal colic
B) hematuria
C) acute kidney injury
D) ketones

Question 65

A client is diagnosed with calcium oxalate kidney stones. What is the appropriate diet therapy for her treatment?

Question 66

Charlie Charlie is prescribed calcium and vitamin D supplements to prevent ____.

A) fluid retention
B) rickets
C) osteopenia
D) renal failure

Question 67

Explain the nephrotic syndrome and the diet modifications used to treat it.

Question 68

Describe the events leading to the development of bone disease in patients with chronic kidney disease.

Question 69

Discuss three of the roles of the kidneys in maintaining our health.

Question 70

Charlie Which diet is the most appropriate for Charlie?

A) high-kcalorie, high-protein
B) high-carbohydrate, high-fat
C) low-fat, low-carbohydrate
D) adequate-protein, low-sodium, low-fat

Question 71

Jasmine Singh Which dietary factors are most important to prevent kidney stones in Jasmine's case?

A) adequate calcium, moderate protein, controlled sodium
B) high protein/high kcalorie with fluid restriction
C) low purine with plenty of fluids
D) low protein with fluid restriction

Question 72

Explain how chronic kidney disease can lead to cardiovascular complications.

Question 73

Jasmine Singh Jasmine has been diagnosed with a kidney stone. The blood in Jasmine's urine is most likely a result of ____.

A) damage from the stone passing through the ureter
B) irritation of the lining of the rectum
C) infection from the stone obstructing the convoluted tubules
D) ketones in the urine from elevated glucose

Question 74

Charlie is a 2½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency department because of increased lethargy, high fever, edema, and foamy urine. His laboratory results reveal proteinuria, hypoalbuminemia, and hyperlipidemia. What is Charlie suffering from?

A) cystic fibrosis
B) type 1 diabetes
C) nephrotic syndrome
D) uremic syndrome

Question 75

Jasmine Singh During flu season Jasmine wants to take high-dose vitamin C supplements as prophylaxis. What is the most appropriate response?

A) Take 2000-mg vitamin C supplements twice daily
B) Take a combination of vitamin C supplements and food sources of vitamin C
C) Avoid vitamin C supplements, since they degrade to oxalate, which increases the risk for stones
D) Take high-dose vitamin D supplements along with vitamin C

Question 76

Charlie Which part of Charlie's body is malfunctioning and causing this condition?

A) beta cells
B) neurons
C) lymphatic system
D) glomerulus