Exam 4: Acute Kidney Injury NCLEX Questions
c
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 <30 mL/min/1.73m2.
d
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)
d
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
c d
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
d
Which initial manifestation of acute renal failure is most common? a. dysuria b. anuria c. hematuria d. oliguria
a
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
c
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
d
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
b
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-protein snacks between meals.
a
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.
d
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
b
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)
b
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
b d
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
c
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
c
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
a b d e
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.
a
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
b
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
c
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
d
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.
c
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. b. preventing hypertension. c. maintaining cardiac output. d. diluting nephrotoxic substances.
a b c d
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
a b d
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
a
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
d
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
c
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 b. plan to administer nitroprusside c. prepare to administer a fluid challenge d. plan to position the client in Trendelenburg
d
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
d
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.
c e
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
a
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."
a b c e
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
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.
d
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
d
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
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
a
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
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.
c d e
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
d
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
d
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
b
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).
d
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
c
Which abnormal blood value would not be improved by dialysis treatment? a. elevated serum creatinine level b. hyperkalemia c. decreased hemoglobin concentration d. hypernatremia
b
Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? a. Hypovolemia b. Hyperkalemia c. Hypernatremia d. Thrombocytopenia
a b e
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
a c
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
