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RENAL-FAILURE-SPINAL-
CORD-INJURY-DIABETES-
MELLITUS QUESTIONS
ACUTE KIDNEY INJURY
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.
b. preventing hypertension. c. maintaining cardiac output. d. diluting nephrotoxic substances. A patient who has acute glomerulonephritis is hospitalized with acute kidney injury (AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine output b. Calcium level c. Cardiac rhythm d. Neurologic status Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)? a. Blood urea nitrogen (BUN) level b. Urine output c. Creatinine level d. Calculated glomerular filtration rate (GFR) In a patient with acute kidney injury (AKI) who requires hemodialysis, a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which intervention will be included in the plan of care? a. Place the patient on bed rest. b. Start continuous pulse oximetry. c. Discontinue the retention catheter. d. Restrict the patients oral protein intake. Which information about a patient who was admitted 10 days previously with acute kidney injury (AKI) caused by dehydration will be most important for the nurse to report to the health care provider? a. The blood urea nitrogen (BUN) level is 67 mg/dL. b. The creatinine level is 3.0 mg/dL. c. Urine output over an 8-hour period is 2500 mL. d. The glomerular filtration rate is < mL/min/1.73m2. After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which action should the nurse take first? a. Document the QRS interval. b. Notify the patients health care provider. c. Look at the patients current blood urea nitrogen (BUN) and creatinine levels. d. Check the chart for the most recent blood potassium level. When caring for a dehydrated patient with acute kidney injury who is oliguric, anemic, and hyperkalemic, which of the following prescribed actions should the nurse take first? a. Insert a urinary retention catheter. b. Place the patient on a cardiac monitor. c. Administer epoetin alfa (Epogen, Procrit).
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
b. plan to administer nitroprusside c. prepare to administer a fluid challenge d. plan to position the client in Trendelenburg A nurse is assessing a client who has prerenal AKI. Which of the following findings should the nurse expect? Select all that apply a. reduced BUN b. elevated cardiac enzymes c. reduced urine output d. elevated blood creatinine e. elevated blood calcium A client has been admitted with acute renal failure. What should the nurse do? Select all that apply a. elevate the HOB 30-45 degrees b. take vital signs c. establish an IV site d. call the admitting healthcare provider for prescriptions e. contact the hemodialysis unit Which initial manifestation of acute renal failure is most common? a. dysuria b. anuria c. hematuria d. oliguria The client who is in acute renal failure has an elevated BUN. What is the likely cause of this finding? a. fluid retention b. hemolysis of RBCs c. below-normal metabolic rate d. reduced renal blood flow A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for a. cardiac arrest b. pulmonary edema c. circulatory collapse d. hemorrhage A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to a. act as a diuretic b. reduce demands on the liver c. help maintain urine acidity d. prevent the development of ketosis The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, which snack is most appropriate? a. a gelatin dessert b. yogurt
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
B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia B. Hyperkalemia In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased due to decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI. Which patient has the greatest risk for prerenal AKI? A. The patient is hypovolemic because of hemorrhage. B. The patient relates a history of chronic urinary tract obstruction. C. The patient has vascular changes related to coagulopathies. D. The patient is receiving antibiotics such as gentamicin. A. The patient is hypovolemic because of hemorrhage. Prerenal causes of AKI are factors external to the kidneys. These factors reduce systemic circulation, causing a reduction in renal blood flow, and they lead to decreased glomerular perfusion and filtration of the kidneys. The patient admitted to the intensive care unit after a motor vehicle accident has been diagnosed with AKI. Which finding indicates the onset of oliguria resulting from AKI? A. Urine output less than 1000 mL for the past 24 hours B. Urine output less than 800 mL for the past 24 hours C. Urine output less than 600 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours The most common initial manifestation of AKI is oliguria, a reduction to urine output to less than 400 mL/day. The patient in the oliguric phase of AKI excreted 300 mL of urine in addition to 100 mL of other losses during the past 24 hours. With appropriate calculations, you determine that for the next 24 hours the patient's fluid allocation is A. 600 mL. B. 800 mL. C. 1000 mL. D. 1200 mL. C. 1000 mL. Fluid intake must be closely monitored during the oliguric phase. The rule for calculating the fluid restriction is to add all losses for the previous 24 hours to 600 mL for insensible losses.
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
A. Progressive irreversible destruction of the kidneys CKD involves progressive, irreversible loss of kidney function. Nurses need to educate patients at risk for CKD. Which individuals are considered to be at increased risk (select all that apply)? A. Older African Americans B. Individuals older than 60 years C. Those with a history of pancreatitis D. Those with a history of hypertension E. Those with a history of type 2 diabetes A. Older African Americans B. Individuals older than 60 years D. Those with a history of hypertension E. Those with a history of type 2 diabetes Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minorities (e.g., African American, Native American). Patients with CKD have an increased incidence of cardiovascular disease related to (select all that apply) A. hypertension. B. vascular calcifications. C. a genetic predisposition. D. hyperinsulinemia causing dyslipidemia. E. increased high-density lipoproteins levels. A. hypertension. B. vascular calcifications. D. hyperinsulinemia causing dyslipidemia. Traditional cardiovascular risk factors, such as hypertension and elevated lipid levels, are common in CKD patients. Hyperinsulinemia stimulates hepatic production of triglycerides. Most patients with uremia develop dyslipidemia. Much of the cardiovascular disease may be related to nontraditional risk factors such as vascular calcification and arterial stiffness. Vascular calcification and arterial stiffness are major contributors to cardiovascular disease in CKD. Calcium deposits in the vascular medial layer are associated with stiffening of the blood vessels. The mechanisms involved are multifactorial and incompletely understood, but they include (1) vascular smooth muscle cells that change into a chondrocyte or osteoblast-like cell, (2) high total body calcium and phosphate levels due to abnormal bone metabolism, (3) impaired renal excretion, and (4) drug therapies to treat the bone disease (e.g., calcium phosphate binders). Measures indicated in the conservative therapy of CKD include A. decreased fluid intake, carbohydrate intake, and protein intake. B. increased fluid intake; decreased carbohydrate intake and protein intake. C. decreased fluid intake and protein intake; increased carbohydrate intake. D. decreased fluid intake and carbohydrate intake; increased protein intake. C. decreased fluid intake and protein intake; increased carbohydrate intake. Water and any other fluids are not routinely restricted in the pre-end-stage renal disease
(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
C. Large urine output Patients frequently experience diuresis in the hours and days immediately after kidney transplantation. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention. An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, what do you tell the patient? A. Successful transplantation usually provides better quality of life than that offered by dialysis. B. If rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. C. The immunosuppressive therapy that is required after transplantation causes fatal malignancies in many patients. D. Hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection. A. Successful transplantation usually provides better quality of life than that offered by dialysis. Kidney transplantation is extremely successful, with 1-year graft survival rates of about 90% for deceased donor transplants and 95% for live donor transplants. An advantage of kidney transplantation compared with dialysis is that it reverses many of the pathophysiologic changes associated with renal failure when normal kidney function is restored. It also eliminates the dependence on dialysis and the accompanying dietary and lifestyle restrictions. Transplantation is also less expensive than dialysis after the first year. A kidney transplant recipient complains of fever, chills, and dysuria over the past 2 days. What is the first action that you should take? A. Assess temperature and initiate a workup to rule out infection. B. Provide warm covers for the patient and give 1 gram of acetaminophen orally. C. Reassure the patient and let him know this is common after transplantation. D. Notify the nephrologist that the patient has developed symptoms of acute rejection. The nurse is caring for a client with acute kidney injury (AKI). Which condition should the nurse recognize as a possible cause for this disease? (Select all that apply.) A. Severe heart failure B. Major trauma C. Radiologic contrast media D. Hemorrhage E. Cerebrovascular disease The nurse preceptor is teaching a new graduate about conditions that can cause damage to the renal parenchyma and nephrons resulting in acute kidney injury (AKI). Which condition should the nurse preceptor include? (Select all that apply.) A. Glomerulonephritis B. Hemolysis C. Dehydration D. Hypertension E. Vasculitis
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.
C. "This is temporary access for dialysis." D. "This fistula is created by joining two arteries together." Which data should the nurse collect when completing a physical examination on a client experiencing acute kidney injury (AKI)? (Select all that apply.) A. Weight B. Reports of edema C. Lung sounds D. History of diabetes mellitus E. Skin color The nurse is completing a health history on a client admitted with acute renal failure. Which information should the nurse collect? (Select all that apply.) A. Recent exposure to nephrotoxic medications B. Reports of weight loss C. Reports of anorexia D. Previous transfusion reactions E. Chronic diseases The nurse is providing discharge instructions to a client going home on 80mg of furosemide (Lasix), a loop diuretic, twice a day. Which teaching should be included in these instructions? (Select all that apply.) A. Take with water only." B. "Avoid using nonsteroidal anti-inflammatory drugs (NSAIDs)." C. "Rise slowly from lying or sitting position." D. "Do not take at the same time as other medications." E. "Take in the morning and at bedtime." For which reason did the nurse place a chair scale in the room of a client who has been admitted with acute kidney injury (AKI)? (Select all that apply.) A. Because equipment calibration can vary B. To ensure an accurate weight C. Limited availability of equipment D. To utilize standard technique E. Because chair scales are the most accurate The nurse notes that the plan of care for a client with acute kidney injury (AKI) instructs them to reposition the client every 2 hours while in bed. Which is the rationale behind this instruction? A. To avoid skin breakdown B. To keep skin dry C. To avoid bone fractures D. To keep the client awake
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.
