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ACUTE KIDNEY INJURY REVISION
Which descriptions characterize AKI?
Select all that apply
a. primary cause of death is infection
b. it almost always affects older people
c. disease course is potentially
reversible
d. most common cause is diabetic
nephropathy
e. cardiovascular disease is most common
cause of death
During the oliguric phase of AKI, the nurse
monitors the patient for Select all that
apply
a. hypotension
b. ECG changes
c. hypernatremia
d. pulmonary edema
e. urine with high specific gravity
If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. hyperkalemia and hyponatremia b. hyperkalemia and hypernatremia c. hypokalemia and hyponatremia d. hypokalemia and hypernatremia The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? a. Provide foods high in potassium. b. Restrict fluids based on urine output. c. Monitor output from peritoneal dialysis. d. Offer high-protRein snacks between meals. When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? a. Weigh patient three times weekly. b. Increase dietary sodium and potassium. c. Provide a low-protein, high-carbohydrate diet. d. Restrict fluids according to previous daily loss Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? a. IV tobramycin b. Incompatible blood transfusion c. Poststreptococcal glomerulonephritis d. Dissecting abdominal aortic aneurysm The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a. Monitor the patient's cardiac status. b. Teach the patient about hand washing. c. Obtain a serum specimen for electrolytes. d. Increase direct observation of the patient.
Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI)? Select all that apply a. Dehydration b. Hypokalemia c. Hypernatremia d. BUN increases e. Urine output increases An unlicensed assistive personnel (UAP) reports to the RN that a patient with acute kidney failure had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks the nurse how this can happen. What is the nurse's best response? a. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics." b. "There must be some sort of error. Someone must have failed to record the urine output." c. "A patient with acute kidney failure retains sodium and water, which counteracts the action of the furosemide." d. "The gradual accumulation of nitrogenous waste products results in the retention of water and sodium." The RN supervising a senior nursing student is discussing methods for preventing acute kidney injury (AKI). Which points would the RN be sure to include in this discussion? Select all that apply a. Encourage patients to avoid dehydration by drinking adequate fluids. b. Instruct patients to drink extra fluids during periods of strenuous exercise. c. Immediately report a urine output of less than 2 mL/kg/hr. d. Record intake and output and weigh patients daily. e. Monitor laboratory values that reflect kidney function. For which patient is the nurse most concerned about the risk for developing kidney disease? a. A 25-year-old patient who developed a urinary tract infection (UTI) during pregnancy b. A 55-year-old patient with a history of kidney stones c. A 63-year-old patient with type 2 diabetes d. A 79-year-old patient with stress urinary incontinence A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will assess the patient for a. vasodilation. b. poor skin turgor. c. bounding pulses. d. rapid respirations. A patient with severe heart failure develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet the goal of a. replacing fluid volume.
d. Give sodium polystyrene sulfonate (Kayexalate). What are intrarenal causes of AKI? Select all that apply a. anaphylaxis b. renal stones c. nephrotoxic drugs d. acute glomerulonephritis e. tubular obstruction by myoglobin An 83 year old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in this patient? Select all that apply a. anaphylaxis b. renal calculi c. hypovolemia d. nephrotoxic drugs e. decreased cardiac output ATN is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. patient with DM b. patient with hypertensive crisis c. patient who tried to overdose on acetaminophen d. patient with major surgery who required a blood transfusion What indicates to the nurse that a patient with oliguria has prerenal oliguria? a. urine testing reveals a low specific gravity b. causative factor is malignant hypertension c. urine testing reveals a high sodium concentration d. reversal of oliguria occurs with fluid replacement Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of a. excretion of sodium b. excretion of bicarbonate c. conservation of potassium d. excretion of hydrogen ions What indicates to the nurse that a patient with AKI is in the recovery phase? a. a return to normal weight b. a urine output of 3,700 mL/day c. decreasing sodium and potassium levels d. decreasing BUN and creatinine levels
While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the HCP? a. urine output is 300 ml/day b. edema occurs in the feet, legs, and sacral area c. cardiac monitor reveals a depressed T wave and elevated ST segment d. the patient experiences increasing muscle weakness and abdominal cramping In caring for the patient with AKI, of what should the nurse be aware? a. the most common cause of death is irreversible metabolic acidosis b. during the oliguric phase, daily fluid intake is limited to 1,000 ml plus the prior day's measured fluid loss c. dietary sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output d. one of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights A 68 year old man with a history of HF resulting from HTN has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 with cardiac changes, BUN is 108, serum creatinine 4.1, and serum HCO3 13. He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. loop diuretics b. renal replacement therapy c. insulin and sodium bicarbonate d. sodium polystyrene sulfonate (kayexalate) A patient with AKI has a serum potassium level of 6.7 and the following ABG results: pH: 7.28, PaCO2: 30, PaO2: 86, HCO3: 18. The nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value? a. pH b. potassium level c. bicarbonate level d. carbon dioxide level A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for use of CRRT? a. pericarditis b. hyperkalemia c. fluid overload d. hypernatremia A nurse is planning care for a client who has prerenal AKI following abdominal aortic aneurysm repair. Urinary output is 60 ml in the past 2 hours, and BP is 92/58. The nurse should expect which of the following interventions? a. prepare the client for a CT scan with contrast dye
c. an orange d. peanuts In the oliguric phase of acute renal failure, the nurse should assess the client for a. pulmonary edema b. metabolic alkalosis c. hypotension d. hypokalemia The client in acute renal failure has an external cannula inserted in the forearm for hemodialysis. Which nursing measure is appropriate for the care of this client? a. use the unaffected arm for blood pressure measurements b. draw blood from the cannula for routine laboratory work c. percuss the cannula for bruits each shift d. inject heparin into the cannula each shift During dialysis, the client has disequilibrium syndrome. The nurse should first a. administer oxygen per nasal cannula b. slow the rate of dialysis c. reassure the client that the symptoms are normal d. place the client in Trendelenburg's position Which abnormal blood value would not be improved by dialysis treatment? a. elevated serum creatinine level b. hyperkalemia c. decreased hemoglobin concentration d. hypernatremia The client with acute renal failure is recovering and asks the nurse, "will my kidneys ever function normally again?" The nurse's response is based on the knowledge that the client's renal status will most likely a. continue to improve over a period of weeks b. result in the need for permanent hemodialysis c. improve only if the client receives a renal transplant d. result in end-stage renal failure A client with AKI has a serum potassium level of 7.0. The nurse should plan which actions as a priority? Select all that apply a. place the client on a cardiac monitor b. notify the HCP c. put the client on NPO status except for ice chips d. review the client's medications to determine if any contain or retain potassium e. allow an extra 500 ml of IV fluid intake to dilute the electrolyte concentration
Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? a. Hypovolemia b. Hyperkalemia c. Hypernatremia d. Thrombocytopenia Which patient has the greatest risk for prerenal AKI? a. The patient who is hypovolemic because of hemorrhage. b. The patient who relates a history of chronic urinary tract obstruction. c. The patient with vascular changes related to coagulopathies. d. The patient receiving antibiotics such as gentamicin. Important nursing interventions for the patient with AKI are Select all that apply a. careful monitoring of intake and output. b. daily patient weights. c. meticulous aseptic technique. d. increase intake of vitamin A and D. e. frequent mouth care. How do you determine that a patient's oliguria is associated with acute renal failure (ARF)? A. Specific gravity of urine at 3 different times is 1.010. B. The serum creatinine level is normal. C. The blood urea nitrogen (BUN) level is normal or below. D. Hypokalemia is identified. A. Specific gravity of urine at 3 different times is 1.010. A urinalysis may show casts, red blood cells (RBCs), white blood cells (WBCs), a specific gravity fixed at about 1.010, and urine osmolality at about 300 mOsm/kg. When caring for a patient during the oliguric phase of acute kidney injury, what would be an appropriate nursing intervention? A. Weigh patient three times weekly B. Increase dietary sodium and potassium C. Provide a low-protein, high-carbohydrate diet D. Restrict fluids according to the previous day's fluid loss D. Restrict fluids according to the previous day's fluid loss Patients in the oliguric phase of acute kidney injury have fluid volume excess with potassium and sodium retention. They will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24- hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times per week. Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia
Your plan for care of a patient with AKI includes which goal of dietary management? A. Provide sufficient calories while preventing nitrogen excess. B. Deliver adequate calories while restricting fat and protein intake. C. Replace protein intake with enough fat intake to sustain metabolism. D. Restrict fluids, increase potassium intake, and regulate sodium intake. A. Provide sufficient calories while preventing nitrogen excess. The challenge of nutrition management in AKI is to provide adequate calories to prevent catabolism despite the restrictions required to prevent electrolyte and fluid disorders and azotemia (accumulation of nitrogen and wastes in blood). For the patient with AKI, which laboratory result would cause you the greatest concern? A. Potassium level of 5.9 mEq/L B. BUN level of 25 mg/dL C. Sodium level of 144 mEq/L D. pH of 7. A. Potassium level of 5.9 mEq/L Hyperkalemia is one of the most serious complications in AKI because it can cause life- threatening cardiac dysrhythmias. Important nursing interventions for the patient with AKI are (select all that apply) A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. D. increase intake of vitamin A and D. E. frequent mouth care. A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. E. frequent mouth care. You have an important role in managing fluid and electrolyte balance during the oliguric and diuretic phases of AKI. Observing and recording accurate intake and output are essential. Measure daily weights with the same scale at the same time each day to assess excessive gains or losses of body fluids. Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membrane. What characterizes AKI (select all that apply)? A. Primary cause of death is infection. B. It usually affects older people. C. The disease course is potentially reversible. D. The most common cause is diabetic nephropathy. E. Cardiovascular disease is the most common cause of death. A. Primary cause of death is infection. C. The disease course is potentially reversible. AKI is potentially reversible. It has a high mortality rate, and the primary cause of death is infection; the primary cause of death for chronic kidney failure is cardiovascular disease. AKI commonly follows severe, prolonged hypotension or hypovolemia or exposure to a
nephrotoxic agent. Although it can occur at any age, the older adult is more susceptible to AKI because the number of functioning nephrons decreases with age. During the oliguric phase of AKI, you monitor the patient for (select all that apply) A. hypertension. B. electrocardiographic (ECG) changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity. A. hypertension. B. electrocardiographic (ECG) changes. D. pulmonary edema. You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended and have a bounding pulse. If a patient is in the diuretic phase of AKI, you must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia C. Hypokalemia and hyponatremia In the diuretic phase of AKI, the kidneys have recovered their ability to excrete wastes but not to concentrate the urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration. You are preparing to administer a dose of PhosLo to a patient with chronic kidney disease (CKD). This medication should have a beneficial effect on which laboratory value? A. Sodium B. Potassium C. Magnesium D. Phosphorus D. Phosphorus Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen in CKD. A patient is admitted to the hospital with CKD. You understand that this condition is characterized by A. Progressive irreversible destruction of the kidneys B. A rapid decrease in urinary output with an elevated BUN level C. Increasing creatinine clearance with a decrease in urinary output D. Prostration, somnolence, and confusion with coma and imminent death
(ESRD) stages. Patients on hemodialysis have a more restricted diet than patients receiving peritoneal dialysis. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. Generally, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains are no more than 1 to 3 kg between dialyses (interdialytic weight gain). For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is being studied. Historically, dietary counseling often encouraged restriction of protein for CKD patients. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, you should teach patients to avoid high-protein diets and supplements because they may overstress the diseased kidneys. The advantage of continuous replacement therapy over hemodialysis is its ability to A. remove fluid without the use of a dialysate. B. remove fluid in less than 24 hours. C. allow the patient to receive the therapy at the work site. D. be administered through a peripheral line. A. remove fluid without the use of a dialysate. Several features of continuous replacement therapy are different from those of hemodialysis. Solute removal can occur by convection (no dialysate required) in addition to osmosis and diffusion. The process can take days or weeks. The patient cannot receive the therapy at work and a vascular access device is required. You are caring for a patient receiving continuous replacement therapy and notice that the filtrate is blood tinged. What is your priority action? A. Place the patient in Trendelenburg position. B. Initiate a peripheral intravenous line. C. Suspend treatment immediately. D. Administer vitamin K (Aquamephyton) per order. C. Suspend treatment immediately. The ultrafiltrate should be clear yellow, and specimens may be obtained for evaluation of serum chemistries. If the ultrafiltrate becomes bloody or blood tinged, a possible rupture in the filter membrane should be suspected, and treatment is suspended immediately to prevent blood loss and infection. A patient with a history of end-stage renal disease (ESRD) resulting from diabetes mellitus has presented to the outpatient dialysis unit for his scheduled hemodialysis. Which assessment should you prioritize before, during, and after his treatment? A. Level of consciousness B. Blood pressure and fluid balance C. Temperature, heart rate, and blood pressure D. Assessment for signs and symptoms of infection B. Blood pressure and fluid balance Although all of the assessments are relevant to the care of a patient receiving hemodialysis, the
nature of the procedure indicates a particular need to monitor blood pressure and fluid balance. Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) is of highest priority when teaching a patient new to this procedure? A. "It is essential that you maintain aseptic technique to prevent peritonitis." B. "You will be allowed a more liberal protein diet after you complete CAPD." C. "It is important for you to maintain a daily written record of blood pressure and weight." D. "You must continue regular medical and nursing follow-up visits while performing CAPD." A. "It is essential that you maintain aseptic technique to prevent peritonitis." Peritonitis is a potentially fatal complication of peritoneal dialysis, and it is imperative to teach the patient methods to prevent it from occurring. Although the other teaching statements are accurate, they do not address the potential for mortality by peritonitis, making that nursing action the highest priority. How should you assess the patency of a newly placed arteriovenous graft for dialysis? A. Irrigate the graft daily with low-dose heparin. B. Monitor for any increase in blood pressure in the affected arm. C. Listen with a stethoscope over the graft for presence of a bruit. D. Frequently monitor the pulses and neurovascular status distal to the graft. C. Listen with a stethoscope over the graft for presence of a bruit. A thrill can be felt by palpating the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein. What are the main advantages of peritoneal dialysis compared to hemodialysis? A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. B. The diet is less restricted and dialysis can be performed at home. C. The dialysate is biocompatible and causes no long-term consequences. D. High glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss. B. The diet is less restricted and dialysis can be performed at home. Advantages of peritoneal dialysis include fewer dietary restrictions and home dialysis is possible. A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours earlier. What is an expected assessment finding for this patient during the early stage of recovery? A. Hypokalemia B. Hyponatremia C. Large urine output D. Leukocytosis with cloudy urine output
The nurse is caring for a critically-ill client who experienced significant blood loss during surgery. Which concern related to the client's risk for prerenal acute kidney injury (AKI) should the nurse consider the priority? A. Fluid overload B. Hyperperfusion C. Urinary obstruction D. Diminished cardiac output The nurse is describing to a colleague how the accumulation of metabolites in the blood from renal failure affects the body. Which effect should the nurse include? A. Decreased levels of nitrogenous wastes in blood B. Increased pain C. Altered electrolyte balance D. Bradycardia A nurse is caring for a pregnant woman. Which physiologic condition may occur during pregnancy and is related to the development of acute kidney injury (AKI) that should concern the nurse? (Select all that apply.) The nurse is reviewing discharge instructions with a client with acute renal injury (AKI). Which diet instruction should the nurse include? (Select all that apply.) A. Eat high-calcium foods. B. Eat foods low in saturated fat. C. Eat foods high in potassium. D. Eat low-phosphorus foods. E. Eat foods low in potassium. The nurse is discussing management of acute kidney injury (AKI) with the client. Which would describe the key goal to managing this condition? A. Maintaining fluid and electrolyte balance B. Avoiding the use of diuretics C. Eating more vegetables that are low in iron D. Drinking more fluids The nurse is discussing medications with a client with acute kidney injury (AKI) upon discharge. Which should be included in the teaching? A. Preeclampsia B. Hypoglycemia C. Hypertension D. Hyperemesis gravidarum E. Hydronephrosis A. Avoid taking acetaminophen (Tylenol). B. Avoid taking NSAIDS. C. Avoid taking blood pressure medication at night. D. Avoid taking iron supplementation.
The nurse describes the increased risk of gastrointestinal bleeding to a client with AKI. Which factor should the nurse inform the client about with regard to medication? (Select all that apply.) A. "Avoid magnesium-based antacids." B. "Regular doses of antacids are indicated." C. "Take antacids at bedtime." D. "Over-the-counter calcium carbonate (Tums) is helpful." E. "Drink milk to coat the stomach prior to taking medication." A 63-year-old man is admitted with postrenal acute kidney injury (AKI) because of a kidney stone. Vascular volume and renal perfusion have been restored and he is on fluid restriction. During the past 24 hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should the client receive over the next 24 hours? A. 2750 mL B. 1250 mL C. 750 mL D. 3000 mL A client diagnosed with acute kidney injury (AKI) is experiencing hyperkalemia. Which medication should the nurse anticipate being prescribed to this client? (Select all that apply.) A. Angiotensin-converting enzyme (ACE) inhibitors B. Glucose C. Insulin D. Sodium bicarbonate E. Calcium chloride A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for insulin to help lower the serum potassium level. Which beneficial action does this medication have for this client? A. Pulls fluid from the cells B. Lowers the blood glucose rate C. Drives the potassium back into the cells D. Acts as an anticoagulant The nurse is treating a client with a serum potassium level of 6.7mEq/L who is already on restricted potassium intake. Which medication may be ordered to reduce the neuromuscular effects of this increased serum level? A. Antibiotic B. H2-receptor antagonist C. Calcium chloride D. Lactated Ringer A client is being discharged following the placement of an AV fistula. The nurse is providing discharge instructions to the client regarding the fistula. Which should the nurse share during this session? A. "The fistula will not be functional for dialysis for a month." B. "The fistula will heal within a week."
ACUTE KIDNEY INJURY & CHRONIC
KIDNEY INJURY
What are intrarenal causes of acute kidney injury (AKI) (select all that apply)? a. Anaphylaxis b. Renal stones c. Bladder cancer d. Nephrotoxic drugs e. Acute glomerulonephritis f. Tubular obstruction by myoglobin An 83-year-old female patient was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in this patient (select all that apply)? a. Anaphylaxis b. Renal calculi c. Hypovolemia d. Nephrotoxic drugs e. Decreased cardiac output Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. Patient with diabetes mellitus b. Patient with hypertensive crisis c. Patient who tried to overdose on acetaminophen d. Patient with major surgery who required a blood transfusion Priority Decision: A dehydrated patient is in the Injury stage of the RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this patient? a. Assess daily weight b. IV administration of fluid and furosemide (Lasix) c. IV administration of insulin and sodium bicarbonate d. Urinalysis to check for sediment, osmolality, sodium, and specific gravity treatment. What indicates to the nurse that a patient with oliguria has prerenal oliguria? a. Urine testing reveals a low specific gravity. b. Causative factor is malignant hypertension. c. Urine testing reveals a high sodium concentration. d. Reversal of oliguria occurs with fluid replacement. In a patient with AKI, which laboratory urinalysis result indicates tubular damage? a. Hematuria b. Specific gravity fixed at 1. c. Urine sodium of 12 mEq/L (12 mmol/L) d. Osmolality of 1000 mOsm/kg ( mmol/kg) Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of a. ammonia synthesis. b. excretion of sodium. c. excretion of bicarbonate.
d. conservation of potassium. What indicates to the nurse that a patient with AKI is in the recovery phase? a. A return to normal weight b. A urine output of 3700 mL/day c. Decreasing sodium and potassium levels d. Decreasing blood urea nitrogen (BUN) and creatinine levels While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify the health care provider? a. Urine output is 300 mL/day. b. Edema occurs in the feet, legs, and sacral area. c. Cardiac monitor reveals a depressed T wave and elevated ST segment. d. The patient experiences increasing muscle weakness and abdominal cramping. In caring for the patient with AKI, what should the nurse be aware of? a. The most common cause of death in AKI is irreversible metabolic acidosis. b. During the oliguric phase of AKI, daily fluid intake is limited to 1000 mL plus the prior day's measured fluid loss. c. Dietary sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output. d. One of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights. A 68-year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 mEq/L (6.2 mmol/L) with cardiac changes, his BUN is 108 mg/dL (38.6 mmol/L), his serum creatinine is 4. mg/dL (362 mmol/L), and his serum HCO3− is 14 mEq/L (14 mmol/L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. Loop diuretics b. Renal replacement therapy c. Insulin and sodium bicarbonate d. Sodium polystyrene sulfonate (Kayexalate) Prevention of AKI is important because of the high mortality rate. Which patients are at increased risk for AKI (select all that apply)? a. An 86-year-old woman scheduled for a cardiac catheterization b. A 48-year-old man with multiple injuries from a motor vehicle accident c. A 32-year-old woman following a C-section delivery for abruptio placentae d. A 64-year-old woman with chronic heart failure admitted with bloody stools e. A 58-year-old man with prostate cancer undergoing preoperative workup for prostatectomya, b, c, d, e. High-risk patients include those exposed Priority Decision: A patient on a medical unit has a potassium level of 6.8 mEq/L. What is the priority action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's blood pressure (BP). c. Instruct the patient to avoid high-potassium foods.
