Acute Kidney Injury Questions

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat: A. hypernatremia B. hypokalemia C. hyperkalemia D. hypercalcemia

C) hyperkalemia Exp. - Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels.

A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority? A. Daily weights B. Intake and output C. Serum potassium D. Blood urea nitrogen

C) serum potassium

The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included? A. Calorie restriction based on ideal body weight is necessary B. Sodium and potassium should be supplemented while on dialysis C. Renal diet restrictions take the place of those for diabetes mellitus D. Moderate protein restriction is recommended while otherwise healthy

D) Moderate protein restriction is recommended while otherwise healthy

A patient develops toxic acute tubular necrosis (ATN) as a result of exposure to a radiocontrast dye. Which of the following should the nurse most expect to observe in this patient as the condition progresses beyond the onset phase? A. Normal K+ levels B. Duration of 7-14 days C. Normal urine concentration function D. Normal urine volume

D) Normal urine volume.

A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task? A. Restricting the patient's protein intake B. Monitoring the patient's potassium level C. Evaluating the patient for signs of nephrotoxicity D. Preventing fluid overload

D) Preventing fluid overload

A client admitted with a gunshot wound to the abdomen is transferred to the intensive care unit after an exploratory laparotomy. I.V. fluid is being infused at 150 ml/hour. Which assessment finding suggests that the client is experiencing acute renal failure (ARF)? A. blood urea nitrogen (BUN) level of 22 mg/dl (1.2 mmol/L) B. serum creatinine level of 1.2 mg/dl (0.1 mmol/L) C. temperature of 100.2° F (37.8° C) D. urine output of 250 ml/24 hours

D) urine output of 250 mL/24 hours Exp. - ARF, characterized by abrupt loss of kidney function, commonly causes oliguria, which is characterized by a urine output of 250 ml/24 hours. A serum creatinine level of 1.2 mg/dl isn't diagnostic of ARF. A BUN level of 22 mg/dl or a temperature of 100.2° F (37.8° C) wouldn't result from this disorder.

An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patient's acute kidney injury? A. Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells B. Obstruction of the flow of urine due to benign prostatic hypertrophy C. Lack of perfusion due to congestive heart failure D. Hypotension due to systemic inflammatory response to sepsis

B) Obstruction of the flow of urine due to benign prostatic hypertrophy.

The patient is in hypovolemic shock, with mean arterial pressures below 90 mm Hg and a very low urine output. An IV drip of norepinephrine is prescribed to keep blood pressure above 90 mm Hg. No other therapy is initiated. What effect on kidney function does the nurse expect? A. Improvement in renal perfusion secondary to improved blood pressure B. Reduction in urine output secondary to constriction of renal arteries C. Augmentation of water reabsorption from distal tubular fluid D. Decrease in urine sodium concentration to critically low levels

B) Reduction in urine output secondary to constriction of renal arteries

A patient in intensive care with acute tubular necrosis from a toxic ingestion has been started on renal replacement therapy. The family expresses concern that the patient will not be able to afford dialysis after discharge from the hospital. In responding to the family, what should the nurse consider? A. The family is in crisis and unable to respond rationally B. Toxic acute tubular necrosis has a higher likelihood of complete healing C. Since the patient is currently oliguric, renal replacement therapy is indicated D. The patient is unlikely to survive this illness, so the cost of long-term dialysis is not an issue

B) Toxic acute tubular necrosis has a higher likelihood of complete healing

The nurse is caring for a client with acute renal failure and edema. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply. A. Administer furosemide orally twice a day. B. Make sure the urinal is within the client's reach. C. Assess breath sounds. D. Remind the client that all urine is to be saved for intake and output measurement. E. Weigh the client every morning using the standing scale. F. Measure and record vital signs.

B, D, E, F) Exp. - Administration of oral medications can be performed by a licensed nurse, and assessment of breath sounds requires additional education and skill development, such as in the scope of practice of the RN. All other actions are within the scope of practice for UAPs.

A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI? A. Fluid overload B. Anemia C. Metabolic acidosis D. Pericarditis

C) Metabolic acidosis

A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation? A. Toxic levels of medications B. Poststreptococcal glomerulonephritis C. Severe sepsis and shock D. Benign prostatic hypertrophy

C) Severe sepsis and shock

A patient with chronic renal disease has mild metabolic acidosis with a pH 7.30 and bicarbonate level 16 mEq/L. What treatment does the nurse anticipate? A. IV sodium bicarbonate B. Reduction of respiratory rate C. Sodium citrate and citric acid (Bicitra) D. Massive IV fluids

C) Sodium citrate and citric acid (Bicitra)

A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal? A. Distended bladder B. Edema C. Strep throat infection D. Kinked Foley Catheter

C) Strep throat infection

A patient is concerned with her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention? A. When your urine albumin-to-creatinine ratio is greater than 25 mg/g B. When your urine output is less than 0.5 mL/kg/6Hr C. When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73m D. When your urine osmolality is greater than 500 mOsm/kg H2O

C) When your glomerular filtration rate (GFR) falls below 15 mL/min/ 1.73

A patient with AKI demonstrates oliguria, a urine osmolality of 550 mOsm/kg H2O, increased urine specific gravity, urine sodium of 15 mEq/L, and a BUN:creatinine ratio of 23:1. Which of the following is a cause of AKI that would best fit these findings? A. Congestive Heart Failure B. Nephrotoxicity due to aminoglycoside antibiotics C. Hypertension D. Retroperitoneal tumor

A) Congestive Heart Failure

In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure? A. Restrict fluid intake B. Monitor serum K+ C. De-emphasize dialysis D. Monitor serum creatinine

B) Monitor serum K+

A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? (SATA) A. Hypertension B. Arteriosclerotic disease C. Traumatic injury D. Type 2 diabetes mellitus E. Preeclampsia F. Type 1 diabetes mellitus

A, B, D, F

The client with acute renal failure asks the nurse, "Will my kidneys ever function normally again?" What should the nurse tell the client? A. "You will continue to improve over a period of weeks." B. "You will likely need dialysis." C. "You will improve when you have a kidney transplant." D. "You will have more kidney damage in several years."

A) "You will continue to improve over a period of weeks." Exp. - The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. The client should be taught how to recognize the signs and symptoms of decreasing renal function and to notify the health care provider (HCP) if such problems occur.

A patient with chronic kidney disease has a serum K+ level of 5 mEq/L and no changes on the ECG. What is the proper nursing intervention? A. Administer sodium polystyrene as an enema B. Administer IV calcium gluconate C. Administer IV insulin and dextrose D. Begin dialysis

A) Administer sodium polystyrene as an enema

A patient with a history of diabetes mellitus has had a procedure using radiocontrast dye. The patient's laboratory results include high urine sodium, urine with muddy-brown granular casts and tubular epithelial cells, and increased blood urea nitrogen (BUN) and serum creatinine. Renal ultrasonography is normal. Urine volume is normal. Which treatment does the nurse anticipate? A. Increased fluids B. Renal stent placement C. Irrigation of urinary catheter D. Diuretic therapy

A) Increased fluids

A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patient's question, what should the nurse most consider? A. The patient most likely has preexisting chronic anemia B. Erythropoietin is primarily produced in the kidney C. The patient is receiving low-dose aspirin therapy D. Chronic renal failure results in persistent uremia

B) Erythropoietin is primarily produced in the kidney

A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is most important for the nurse to monitor? A. Blood pressure B. Fluid volume recovery C. Urine output D. Cardiac dysrhythmias

B) Fluid volume recovery

A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process? A. It lowers the level of blood glucose B. It prevents nephron hyperfiltration C. It increases the urine output D. It filters waste from the blood

B) It prevents nephron hyperfiltration

A patient has just been diagnosed with type 2 diabetes mellitus. During teaching, what strategy should the nurse emphasize as protective of kidney cells? A. Monitoring glycosylated hemoglobin every 3 months B. Strict adherence to prescribed weight-loss diet C. Restriction of sodium-containing beverages and food D. Strict control of serum glucose levels with diet and medication

D) Strict control of serum glucose levels with diet and medication

A client requires hemodialysis. Which type of drug should be withheld before this procedure? A. phosphate binders B. insulin C. antibiotics D. cardiac glycosides

D) cardiac glycosides Exp. - Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occurs during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digoxin toxicity. Phosphate binders and insulin can be administered because they aren't removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects.