Chapter 34: Acute Kidney Injury and Chronic Kidney Disease

Which individual likely faces the greatest risk for the development of chronic kidney disease?

A client with a recent diagnosis of type 2 diabetes who does not monitor blood sugars or control diet

Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. What are the most common causes of ischemic ATN? Select all that apply.

Severe hypovolemia Burns Overwhelming sepsis

An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client's admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which early sign of prerenal injury?

Sharp decrease in urine output

With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?

"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."

Which clinical manifestation is the most common indicator of acute kidney injury?

Azotemia

The nurse recognizes that acute renal injury is characterized by which of the following?

Rapid decline in renal function

A 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client's concern?

"Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately."

Which conditions have the potential to cause chronic kidney disease? Select all that apply.

- Hypertension - Diabetes - Glomerulonephritis

A client is diagnosed with chronic kidney disease (CKD). The nurse recognizes that which statements regarding CKD are correct? Select all that apply.

- Nephron destruction takes place over many months. - Signs and symptoms develop gradually. - Functioning nephrons compensate for those that are damaged. - There is a reduction in glomerular filtration rate (GFR) as nephrons are destroyed

A hospital client with a diagnosis of chronic renal failure has orders for measurement ofher serum electrolyte levels three times per week. Which of the following statementsbest captures the relationship between renal failure and sodium regulation? A) Clients with advanced renal failure are prone to hyponatremia because ofimpaired tubular reabsorption. B) Renal clients often require a sodium-restricted diet to minimize the excretion loadon remaining nephrons. C) Clients with renal failure often maintain high sodium levels because of decreasedexcretion. D) Restricting sodium intake helps to preserve nephron function and has theadditional benefit of lowering blood pressure

A) Clients with advanced renal failure are prone to hyponatremia because ofimpaired tubular reabsorption.

Which of the following clinical manifestations would lead the nurse to suspect the renalfailure patient is developing uremia? Select all that apply. A) Weakness and fatigue B) Lethargy and confusion C) Extreme itching D) Blood in urine E) Urine smell in the stool

A) Weakness and fatigue B) Lethargy and confusion C) Extreme itching

A client had excessive blood loss and prolonged hypotension during an extensive surgery. The client's postoperative urine output is sharply decreased and the blood urea nitrogen (BUN) is elevated. Which cause is most likely responsible for these abnormal findings?

Acute tubular necrosis

Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?

Anemia

Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure?

Azotemia and a decrease in the GFR

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientatingrecent nursing graduates to the unit. Which of the following teaching points about acutetubular necrosis (ATN) should the educator include in the orientation session? A) "The cardinal signs of ATN are oliguria and retention of potassium, creatinine,and sulfates. "B) "Ureteral and bladder outlet obstructions are often contributors to ATN." C) "Trauma, burns, and major surgery are common precursors to ATN." D) "Tubular epithelial cells are sensitive to ischemia and toxins, and damage isirreversible."

C) "Trauma, burns, and major surgery are common precursors to ATN."

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?

Client with prostatic hyperplasia

The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure? Client with acute pyelonephritis Client with severe hypovolemia Client with intratubular obstruction Client with prostatic hyperplasia

Client with prostatic hyperplasia

A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?

Creatinine

The parents of a child who has been diagnosed with chronic kidney disease (CKD) ask the nurse about manifestations of the disease. Which information is the most appropriate information to provide these parents?

Developmental delay Delayed cognitive development Secondary hyperparathyroidism Growth impairment

The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?

Dietary protein

A client is beginning to recover from acute tubular necrosis. During which phase of acute kidney injury will the nurse assess an increase in urine output?

Diuretic phase

Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?

Diuretics

Which dermatologic problem most often accompanies chronic kidney disease (CKD)? Hirsutism and psoriasis Alopecia and fungal rashes Dry skin and pruritus Petechiae and purpura

Dry skin and pruritus

A client is being treated for chronic kidney disease (CKD). One of the nurse's responsibilities is to explain to the client the need to keep her blood pressure under control. Why is blood pressure control so important in CKD clients?

Elevated blood pressure will exacerbate nephron loss and accelerate renal failure.

A client diagnosed with CKD has begun to experience periods of epistaxis and has developed bruising of the skin and subcutaneous tissues. The nurse recognizes these manifestations as:

Impaired platelet function

Albuminuria is an important indicator of nephron damage. The nurse recognizes that which statements regarding albuminuria are correct? Select all that apply. Increased excretion of low-molecular-weight globulins indicates chronic kidney disease (CKD). Urine dipstick can detect albuminuria. Urine normally contains no protein. Albumin-to-creatinine ratio can confirm albuminuria. Increased excretion of albumin indicates CKD.

Increased excretion of albumin indicates CKD. Urine dipstick can detect albuminuria. Albumin-to-creatinine ratio can confirm albuminuria.

Which of the following data would a clinician consider as most indicative of acute renalfailure? A) Alterations in blood pH; peripheral edema B) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) C) Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassiumand calcium levels D) Decreased urine output; hematuria; increased GFR

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)

A client sustained acute tubular injury approximately 2 hours ago. Which cause of acute kidney injury (AKI) would the nurse suspect the client is experiencing?

Intrarenal

Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?

Kidneys convert inactive vitamin D to its active form, calcitriol.

A client has a marked decrease in the glomerular filtration rate (GFR); lab values with high blood urea nitrogen (BUN), potassium, and creatinine levels; urine output less than 10 mL/hr; 3+ pitting edema in the lower extremities; and BP 170/95. Which phase of acute tubular necrosis (ATN) does the nurse identify the client is in based on assessment data?

Maintenance phase

A nurse caring for a client with acute tubular necrosis (ATN) caused by myoglobinuria knows this may be caused by which finding in the client's medical history?

Muscle damage Hyperthermia Alcohol abuse Prolonged seizures

A client with chronic kidney disease who has renal osteodystrophy should be assessed for which complications? Select all that apply. Stress fractures Bone pain Urosepsis Kidney stones Muscle weakness

Muscle weakness Bone pain Stress fractures

A 35-year-old female ultramarathon runner is admitted to the hospital following aday-long, 50-mile race because her urinary volume is drastically decreased and her urineis dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis.Why is her urine red?

Myoglobinuria

The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?

Obstruction of the renal tubules with myoglobin and damaged tubular cells

A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease?

Pericarditis

An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury?

Prerenal

A client has an obstructive urine outflow related to benign prostatic hyperplasia. Due to the inability to excrete adequate amounts of urine, which type of renal failure should the nurse closely monitor for?

Postrenal failure

A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?

Prerenal failure

Which of the following phenomena contributes to the difficulties with absorption,distribution, and elimination of drugs that are associated with kidney disease?

Reductions in plasma proteins increase the amount of free drug and decrease theamount of protein-bound drug.

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:

a loss of over half the client's normal kidney function.

Which of the following clients would be considered to have a significant risk ofdeveloping the prerenal form of acute renal failure? Select all that apply. A) A 22-year-old male who has lost large amounts of blood following a workplaceinjury B) A 41-year-old female who is admitted for intravenous antibiotic treatment ofpyelonephritis C) A 79-year-old male with diagnoses of poorly controlled diabetes mellitus andheart failure D) A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxicdrug E) A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH) F) An 80-year-old female who has been admitted for the treatment of dehydrationand malnutrition

a, c, f

A client with chronic kidney disease (CKD) has developed asterixis. The nurse knows that asterixis is:

dorsiflexion of hands and feet

A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?

hypertension

A client has acute pyelonephritis. The nurse will monitor the client for development of:

intrarenal failure

A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:

nephrotoxic acute tubular necrosis (ATN).