Acute Kidney Injury Practice Ques
A patient is diagnosed with acute kidney injury (AKI). The patient asks how the function of the kidneys can be assessed. Which statement by the nurse provides an appropriate answer? "Serum osmolality concentrations can provide that information to your healthcare provider." "We monitor the hemoglobin level in the blood." "The healthcare provider assesses serial hematocrit values." "A serum creatinine blood level will be obtained."
"A serum creatinine blood level will be obtained." A diagnostic test used to assess kidney function is serum creatinine level. In AKI, serum creatinine levels increase rapidly, within 24-48 hours of onset. Hemoglobin and hematocrit are used to assess hemoconcentration in the blood. Serum osmolality is the number of particles dissolved per unit of water in the serum. Serum osmolarity is the measure of the concentration of particles in the serum.
A 6-year-old child presents with a history of renal insufficiency. Which question should the nurse ask the parents to assist with the diagnosis of acute kidney injury (AKI)? "How much protein does your child consume each day?" "Can you tell me about your child's past infections?" "Has your child had a recent acute gastrointestinal illness?" "Which previous major surgeries has your child had?"
"Has your child had a recent acute gastrointestinal illness?" Children with renal insufficiency (decrease in the kidneys' ability to conserve sodium and concentrate the urine) are at greatest risk for developing dehydration and acute kidney injury from acute gastrointestinal illness. Therefore, the nurse needs to further question the patient's parents about recent acute gastrointestinal illnesses. Major surgery, infections, and certain medications that are nephrotoxic can increase the risk for AKI in older adult patients.
The nurse is providing discharge teaching for a patient in the recovery phase of acute kidney injury (AKI). Which patient statement demonstrates understanding of the signs of possible dehydration? "My urine appears very clear." "I am up all night going to the bathroom." "I am not urinating much during the day." "I am urinating more than usual."
"I am not urinating much during the day." If the patient is discharged during the recovery phase of AKI, teach the signs and symptoms of complications, including FVE or FVD, heart failure, and electrolyte imbalances. Monitoring intake and output closely is a vital practice to alert the patient and healthcare provider that there may be a problem.
The nurse is performing discharge teaching to a patient recovering from an acute kidney injury (AKI). Which patient statement indicates a need for further teaching on how to manage AKI after discharge? "I will monitor my blood pressure." "I need to avoid NSAIDs for 1 month." "I will monitor for symptoms of possible relapse." "I need to avoid life stressors."
"I need to avoid NSAIDs for 1 month." A patient recovering from AKI needs to avoid nephrotoxic drugs for up to 1 year, not 1 month. The patient will need to continue monitoring blood pressure and symptoms of possible relapse after discharge, as well as avoid life stressors, which can slow healing.
A patient receiving peritoneal dialysis asks the nurse how it works. Which response by the nurse is accurate? "The fluid that infuses into your abdomen will pull fluid and toxins from the bloodstream, and then the waste products will drain from your abdomen." "Your blood is filtered through an external filter that will pull excess fluid and toxins out of your blood." "The fluid that infuses into your abdomen diffuses into the blood and dilutes the toxins." "Your body exchanges the fluid in the bloodstream with the clean fluid in the abdomen, and then the fluid with the toxins drains out."
"The fluid that infuses into your abdomen will pull fluid and toxins from the bloodstream, and then the waste products will drain from your abdomen." Peritoneal dialysis uses the peritoneal membrane as the dialyzing surface. Metabolic wastes and excess electrolytes diffuse into the dialysate in the abdomen, and an osmotic gradient pulls excess fluid from the blood. Hemodialysis is the process in which the blood volume is filtered through an external filter to remove toxins and excess fluid from the blood. The dialysate fluid does not diffuse into the bloodstream, but remains in the peritoneal space. Fluid is not exchanged in peritoneal dialysis. The same fluid that infuses into the abdomen is what is drained several hours later.
A nurse is providing teaching to a patient scheduled for a renal biopsy. Which statement demonstrates that the teaching has been effective? "They are taking a piece of tissue from my kidney to see why I have blood in my urine." "They are going to check the medication level in my system." "They are taking some tissue from my kidneys to see if it is causing my blood pressure to increase." "They are going to operate on my kidneys."
"They are taking a piece of tissue from my kidney to see why I have blood in my urine." A renal biopsy is the procedure used to extract kidney tissue for laboratory analysis. This can be used to check why the patient has blood in the urine. It demonstrates correct understanding of the process.
A 65-year-old patient with acute kidney injury (AKI) is meeting with the nurse to review their medication regimen at home. Which teaching should the nurse include? Avoiding the use of NSAIDs Taking vitamins daily Taking all prescribed medications in the morning Utilizing only ibuprofen for any pain
Avoiding the use of NSAIDs Etiology of AKI in older adults includes sepsis and the presence of polypharmacy, especially nephrotoxic drugs such as NSAIDs. The drug classification for ibuprofen is an NSAID, so this should be avoided. The patient should be educated to take all of their medication as prescribed, and not alter their schedule. Resuming their vitamin schedule does not have an effect on the diagnosis of AKI.
A patient is in the maintenance phase of acute kidney injury (AKI) and is experiencing oliguria. Which manifestation should the nurse anticipate will increase in severity when compared to a patient with nonoliguric AKI? Azotemia Dehydration Anemia Muscle weakness
Azotemia A patient in the maintenance phase of AKI with oliguria will experience azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis more severely than a patient with nonoliguric AKI, thereby leading to a poorer prognosis. Muscle weakness, anemia, and dehydration typically are not more severe when experiencing oliguria.
The nurse identifies that a patient with acute kidney injury (AKI) is experiencing hyperkalemia. The nurse should monitor the patient for which manifestation? Electrocardiographic changes Hypotension Constipation Weight gain
Electrocardiographic changes Impaired potassium excretion leads to hyperkalemia, which causes electrocardiographic changes. Hypotension, constipation, and weight gain are not manifestations of hyperkalemia.
Which nursing intervention should be a priority for a patient diagnosed with acute kidney injury (AKI) who has an edematous abdomen while hospitalized? Cleanse the patient's skin with an antimicrobial soap. Restrict the patient's movement to decrease the potential fluid shift. Use a hoyer lift to move the patient. Encourage frequent position changes.
Encourage frequent position changes Edema decreases tissue perfusion and increases the risk of skin breakdown, especially in patients who are older or debilitated. It is common practice to reposition patients frequently because the pressure points of the body can break down with constant pressure to that area of skin. The way the skin is cleansed has no effect on an edematous abdomen. A hoyer lift is used to lift an obese patient in and out of bed. The patient should be encouraged to move as often as possible to redistribute the fluid.
Which action by the nurse would be most appropriate to address the nutritional imbalances of an older adult patient with acute kidney injury? Providing a website to research their new diet Planning weekly meals for the patient Having the healthcare provider write up meal plans for the patient Having the patient and family consult with a registered dietitian
Having the patient and family consult with a registered dietitian Arranging for consultation with a dietitian is the most appropriate action. A registered dietitian can assist in planning meals within prescribed limitations that consider the patient's and family's food preferences, especially if the patient follows cultural or religious mandates regarding foods. Diets restricted in protein, salt, and potassium can be unpalatable. A nurse or healthcare provider planning the patient's weekly meals does not necessarily address the patient's preferences within the dietary restrictions. Sending the patient to a website does not ensure accurate understanding and use of information.
The nurse reviews laboratory data for a patient with acute kidney injury (AKI). For which laboratory value should the nurse expect hemodialysis to be ordered? Cell casts in urine Increasing serum potassium level Decreased red blood cells Low serum sodium
Increasing serum potassium level An increasing serum potassium level is an indication for hemodialysis because of its arrhythmogenic effects. Although anemia (decreased red blood cells) and low serum sodium are associated with AKI, they can be managed with therapies other than hemodialysis. Cell casts in the urine are a sign of acute tubular necrosis and cannot be reversed with hemodialysis
A patient admitted for complications from acute kidney injury (AKI) has been prescribed furosemide (Lasix) 80 mg twice daily. Which is most important for the nurse to assess accurately in this patient? Breath sounds Response of pupils to light Bruising Initial weight
Initial weight When a patient is prescribed a loop diuretic such as furosemide (Lasix), the nurse should assess weight and vital signs for baseline data. The loop diuretics, named for their primary site of action in the loop of Henle, are high-ceiling diuretics (the response increases with increasing doses). These are highly effective diuretics used in early AKI to reestablish urine flow and convert oliguric renal failure to nonoliguric renal failure. Assessing breath sounds would be appropriate for a patient who presents with a heart or respiratory issue. Assessing the response of pupils to light would be done to identify neurologic conditions. The nurse would assess for bruising as an indication of bleeding beneath the skin.
A pregnant patient is in the first trimester of pregnancy and has been having a lot of burning and discomfort upon urination and is diagnosed with a urinary tract infection. Which condition should the nurse suspect as a possible cause for this infection? Acute tubular necrosis Physiological hydronephrosis Hyperphosphatemia Hyperkalemia
Physiological hydronephrosis Over 90% of women develop a physiological hydronephrosis of pregnancy, which can promote urinary stasis, leading to urinary tract infection and ultimately acute kidney injury (AKI). Hyperkalemia is an electrolyte imbalance that causes a high level of potassium in the blood. Hyperphosphatemia is another electrolyte imbalance that causes an abnormally high level of phosphate in the blood. Acute tubular necrosis is the death of the tubular cells and is usually caused by low blood pressure or nephrotoxic drugs.
The nurse is caring for a patient with acute kidney injury (AKI) resulting from a urethral obstruction due to cancer. Which type of AKI is the patient experiencing? Postrenal Intrinsic Intrarenal Prerenal
Postrenal Postrenal AKI is a result of any ureteral or urethral obstruction. Prerenal AKI is caused by any disorder that significantly decreases vascular volume, cardiac output, or systemic vascular resistance that can affect renal blood flow. Intrarenal (intrinsic) AKI is caused by diseases of the kidney itself.
A patient is admitted to the medical unit with the diagnosis of postrenal acute kidney injury (AKI). Which should the nurse suspect as a possible cause? Trauma Surgery Ischemia Urinary tract calculi
Urinary tract calculi Obstructive causes of AKI are classified as postrenal. Any condition that prevents urine excretion can lead to postrenal AKI. Benign prostatic hypertrophy is the most common precipitating factor, but this occurs primarily in older men. Other causes include renal or urinary tract calculi and tumors. Ischemia is the deficiency of blood in one or both kidneys. Renal injury is serious but not of the obstructive nature because it generally includes a bruised, torn, or vascular injury. Renal surgery would not be the cause of an obstruction, which is a classic sign of postrenal injury.
The nurse preceptor is working with a new graduate nurse to provide care for a patient with fluid volume overload due to acute kidney injury (AKI). Which statement indicates that the new graduate nurse needs further teaching about interventions that should be implemented for this patient? "I need to limit fluid intake." "I need to administer potassium replacements." "I need to place the patient in a semi-Fowler position." "I need to weigh the patient daily."
"I need to administer potassium replacements." Patients with AKI have hyperkalemia and should not be given potassium supplements. Nursing care for patients with fluid volume overload caused by AKI includes maintaining intake and output measurements and daily weighing to assist in tracking fluid balance. Liberal fluid intake is contraindicated in patients with AKI because of their inability to excrete excess fluid. The semi-Fowler position helps improve respiratory excursion of the patient with fluid overload.
The nurse is teaching a patient with acute kidney injury (AKI) how to diminish lower leg edema. Which patient statement demonstrates effective teaching? "I should only drink one glass of water a day while my legs are swollen." "I should prop my legs up as frequently as possible." "I should not drink alcohol." "I should drink more fluid to help move the excess water through my body."
"I should prop my legs up as frequently as possible." In kidney disease, extra fluid and sodium in the circulation can pool and cause edema in the lower legs and around the eyes. It is important to teach the patient that elevating their legs can decrease the edema. The patient will be on fluid restriction, which should be followed.
A patient with acute kidney injury (AKI) is on fluid restriction. Which statement by the nurse indicates an appropriate intervention? "I should encourage the patient to lose weight." "I should order extra solids with their meals." "I should provide frequent mouth care." "I should monitor weekly intake and output."
"I should provide frequent mouth care." The nurse should provide frequent mouth care and encourage use of hard candies to decrease thirst. Providing frequent mouth care keeps the mucous membrane moist and helps decrease the patient's desire to consume fluids. The proportion of solids in a meal has no connection to fluid restriction. Intake and output should be monitored daily for a patient on fluid restriction. Loss of extra weight affects the overall health of the patient, but it is not an indicator for fluid restriction.
The nurse is teaching a patient about the differences between hemodialysis and peritoneal dialysis. Which statement demonstrates that the patient understands how peritoneal dialysis differs from hemodialysis? "Waste accumulates during peritoneal dialysis." "The waste is removed more slowly." "The waste is removed faster." "Waste is not removed at all."
"The waste is removed more slowly." Because excess fluid and solutes are removed more gradually in peritoneal dialysis, this type of renal replacement therapy poses less risk than other methods for patients who are unstable. However, this slower rate of metabolite removal can be a disadvantage in patients with acute kidney injury (AKI) because it reduces waste removal.
The nurse preceptor is discussing age as a risk factor for acute kidney injury (AKI) in older adults with a graduate nurse. Which statement by the graduate nurse indicates understanding of this risk? "Older adults have more gastrointestinal illnesses." "There are higher levels of waste products present in the blood." "Fluid intake is generally less than the younger population." "Thickening of the renal artery leads to decreased blood flow."
"Thickening of the renal artery leads to decreased blood flow." Older adults are at risk for AKI due to structural changes, including reduction in cortical mass, hyperfiltration of the glomerulus associated with hypertrophy, and thickening of the renal artery, leading to decreased blood flow and further risk of AKI in older adults. They also have decreased renal reserve and declining function interfering with the kidney's ability to recover from AKI.
The nurse is teaching a patient diagnosed with acute kidney injury (AKI) about diet. Which statement should the nurse include? "You should increase the amount of protein in your diet." "Your diet should include an increase in carbohydrates." "You should decrease the amount of dairy in your diet." "You should decrease the amount of fiber in your diet."
"Your diet should include an increase in carbohydrates." Carbohydrates are increased for a patient with AKI in order to maintain adequate caloric intake. For a patient with AKI, protein is limited in the diet to reduce the risk of azotemia. Decreasing dietary fiber and dairy intake is not essential for these patients.
The nurse is caring for a patient with acute kidney injury (AKI). For which urine amount should the nurse report promptly to the healthcare provider? Less than 35 mL/hr Less than 30 mL/hr Less than 45 mL/hr Less than 40 mL/hr
Less than 30 mL/hr The nurse should promptly report a urine output of less than 30 mL/hr or other evidence of decreased cardiac output for a patient with AKI.
In an initial interview, the nurse asks a patient who is newly diagnosed with acute kidney injury (AKI) if they had any radiologic testing using a contrast medium recently. Which would be the purpose of this question? It will complete the patient's health history. Impaired perfusion affects liver functioning. It will prevent recent tests from being repeated. Contrast medium is associated as a cause of AKI.
Contrast medium is associated as a cause of AKI. Contrast-induced nephropathy is an abrupt deterioration in renal function that can be associated with the use of contrast medium. It is important to know if the patient had undergone testing utilizing the contrast to determine if that may be the cause of AKI. In obtaining a health history, the nurse should also ask the patient about complaints of anorexia, nausea, weight gain, or edema; recent exposure to a nephrotoxin, such as an aminoglycoside antibiotic; previous transfusion reaction; and chronic diseases, such as diabetes, heart failure, or kidney disease.
A child is admitted to the hospital with nausea, vomiting, lethargy, and oliguria, and the healthcare provider suspects fluid depletion associated with acute kidney injury (AKI). Which prescribed order should the nurse consider appropriate for this patient? Phosphorous supplement Potassium supplement Low doses of a diuretic Isotonic saline solution
Isotonic saline solution Initial emergency treatment of children with fluid depletion associated with AKI focuses on rapid fluid replacement with 20 mL/kg of 0.9% saline or lactated Ringer's solution given over 5 to 10 minutes and repeated as needed. This ensures renal perfusion and stabilizes blood pressure. Potassium and phosphorous would not be administered because the electrolytes would be expected to be elevated. A diuretic would not be administered because dehydration would be present due to fluid depletion.
The nurse is caring for a patient diagnosed with prerenal acute kidney injury (AKI). Which condition should the nurse recognize as a cause for this disorder? Glomerulonephritis Hyperkalemia Renal calculi Sepsis
Sepsis Prerenal AKI results from conditions that affect renal blood flow and perfusion. Any disorder that significantly decreases vascular volume, cardiac output, or systemic vascular resistance can affect renal blood flow. Sepsis causes prerenal AKI because it causes altered vascular resistance. Renal calculi are the cause of postrenal failure. Fluid retention is not a cause of prerenal AKI. Glomerulonephritis is the cause of intrarenal AKI.
