RN Nursing · Pathophysiology · Practice question
An elderly female client has been hospitalized for the treatment of acute pyelonephritis. Which of the following characteristics of the client is most likely implicated in the etiology of her current health problem? The client:
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Has peripheral vascular disease
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✓
Recently had a urinary tract infection
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Takes a diuretic and an ACE inhibitor each day for the treatment of hypertension
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Has been diagnosed with type 2 diabetes several years earlier
Answer & explanation
Correct: Recently had a urinary tract infection
Acute pyelonephritis is a bacterial infection of the renal parenchyma most commonly caused by ascending organisms, and having a recent urinary tract infection (UTI) is the most directly implicated etiological factor. Untreated or inadequately treated lower UTIs allow pathogens such as Escherichia coli to ascend from the bladder through the ureters to the kidneys, causing pyelonephritis. This is the classic and most common mechanism of upper urinary tract infection. While type 2 diabetes is a predisposing risk factor for UTIs in general due to glucosuria and impaired immune responses, the question asks which characteristic is most likely implicated in the etiology of this specific presentation. A recent UTI provides the direct microbial source and pathway. Peripheral vascular disease contributes to poor tissue perfusion but is not a primary predisposing factor for pyelonephritis. Taking a diuretic and ACE inhibitor affects blood pressure and renal hemodynamics but does not directly predispose a client to ascending bacterial infections. Therefore, a recent UTI is the most direct and specific precursor to the development of pyelonephritis in this client.
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