Acute Kidney Injury
The nursing instructor is evaluating the statements of a nursing student about medication safety for patients with acute kidney injury. Which statement by the student indicates effective learning? "I will caution patients about the use of over-the-counter analgesics." "I will suggest that patients limit the course of antibiotics prescribed." "I will instruct patients to go for a follow-up medical checkup every six months." "I will instruct patients to take antihypertensives if their BP increases."
"I will caution patients about the use of over-the-counter analgesics." Over-the-counter drugs are harmful to the kidneys for patients with preexisting kidney disease and may worsen the symptoms. For example, acetaminophen causes nephrotoxicity and, if overused, may cause kidney failure. An antibiotic course should be completed and not limited because the patient may develop resistance. Patients with renal impairment should visit the health care center regularly to help in the early detection or treatment of further complications associated with chronic kidney disease. Angiotensin-converting enzyme inhibitors are used as antihypertensives and should be taken only when prescribed by a health care provider because of the side effect of hyperkalemia.
The nursing instructor is teaching a nursing student about sodium polystyrene sulfonate. Which statement by the student indicates the need for further teaching? "It can be administered as an enema." "It removes 4 mEq of potassium per 1 gram of drug." "It produces osmotic diarrhea." "It should not be given to a patient with a paralytic ileus."
"It removes 4 mEq of potassium per 1 gram of drug." Sodium polystyrene sulfonate is used to correct hyperkalemia and removes 1 mEq of potassium per 1 g of drug. It can be given by mouth or retention enema. It produces osmotic diarrhea, allowing for evacuation of potassium-rich stool. It should not be given to a patient with a paralytic ileus because bowel necrosis can occur.
A patient who is hospitalized with sepsis is at risk of developing which renal pathology? Nephritis Glomerular nephritis Acute tubular necrosis (ATN) Chronic kidney disease (CKD)
Acute tubular necrosis (ATN) ATN is the most common intrarenal cause of AKI in hospitalized patients. It is primarily the result of ischemia, nephrotoxins, or sepsis. Ischemic and nephrotoxic ATN is responsible for 90% of intrarenal AKI cases. Severe kidney ischemia causes a disruption in the basement membrane and patchy destruction of the tubular epithelium. Nephrotoxic agents cause necrosis of tubular epithelial cells, which slough off and plug the tubules. Nephritis is an acute infection of the nephrons. Glomerular nephritis develops into CKD and is not a result of sepsis.
When assessing a patient with chronic kidney disease (CKD), the nurse recognizes that which neurologic change is common as the disease progresses? Anger Delirium Apathy Restlessness
Apathy Neurologic changes are expected as kidney disease progresses. They are the result of increased nitrogenous waste products, electrolyte imbalances, metabolic acidosis, and atrophy and demyelination of nerve fibers. The central nervous system (CNS) becomes depressed, resulting in lethargy, apathy, decreased ability to concentrate, fatigue, irritability, and altered mental ability. Anger, delirium, and restlessness are not commonly associated with CKD.
The nurse performs an admission assessment of a patient with acute kidney injury. For which common complication does the nurse assess the patient? Polyphagia Hypernatremia Hypotensive shock Cardiac dysrhythmias
Cardiac dysrhythmias Because the kidneys are not effectively removing waste products, including electrolytes, an increased potassium level (hyperkalemia) of more than 5.0 mEq/L is common in acute kidney injury and places the patient at risk for cardiac dysrhythmias. Patients usually experience anorexia, not an increase in hunger (polyphagia). Acute renal failure will likely manifest as hyponatremia. Hypotensive shock may be the result of a severe cardiac arrhythmia that is not treated.
The nurse teaches a patient with acute kidney injury (AKI) about lifestyle modifications. Which actions by the patient indicate effective teaching? Consuming less salt Eating foods rich in protein Increasing intake of fluids Consuming potassium-rich foods
Consuming less salt Sodium causes fluid and water retention and thereby increases blood volume; thus the patient should consume less salt. Patients with renal impairment should decrease protein intake because proteins break down into urea, which is dangerous if it accumulates in the brain. Increasing the intake of fluid will increase the volume of fluid in the body. Because the kidney function is impaired, excess fluid cannot be eliminated and it accumulates in the body, leading to edema and congestive cardiac failure. Kidney disease is associated with hyperkalemia; thus eating potassium-rich food will worsen the condition and may lead to cardiac arrhythmia.
The nurse reviews laboratory tests that are prescribed for a patient with acute kidney injury. Which is the best indicator of renal function? Potassium Creatinine Blood urea nitrogen (BUN) Alanine aminotransferase (ALT)
Creatinine
Which are common causes of acute kidney injury? Select all that apply. Hypovolemia Interstitial nephritis Increased cardiac output Decreased renovascular blood flow Increased peripheral vascular resistance
- Hypovolemia - Interstitial nephritis - Decreased renovascular blood flow Acute kidney injury is defined as rapid loss of kidney function. The common causes of acute renal injury are prerenal, intrarenal, and postrenal. One cause of acute kidney injury is hypovolemia, which is associated with dehydration, diarrhea, burns, and hemorrhage. Interstitial nephritis, which is associated with allergies and infections, is another cause of acute kidney injury. Decreased renovascular blood flow, which is associated with embolism and renal artery thrombosis, is another cause of acute kidney injury. Decreased cardiac output, which is associated with cardiac dysrhythmias and cardiogenic shock, is also a cause of acute kidney injury. Decreased peripheral vascular resistance, which is associated with neurologic injury and septic shock, is another cause of acute kidney injury.
The nursing instructor teaches a nursing student about permanent therapies for hyperkalemia associated with acute kidney injury. Which example given by the student indicates effective learning? Insulin infusion Sodium bicarbonate Calcium gluconate infusion Sodium polystyrene sulfonate
Sodium polystyrene sulfonate Sodium polystyrene sulfonate is a cation-exchange resin that completely removes extra potassium; it is considered a permanent therapy. Insulin pushes potassium inside the cells, but with a decline in insulin levels, potassium exits the cell. Thus insulin is a temporary therapy. Sodium bicarbonate and calcium gluconate are also considered temporary therapies because they shift potassium into the cells until their blood levels diminish, upon which potassium exits the cells.
A patient with acute kidney injury who is experiencing hyperkalemia asks the nurse, "Why is IV insulin being prescribed? And will my blood sugar get too low?" How does the nurse respond? Select all that apply. "Insulin will improve your kidney function." "The potassium levels will be normalized." "Insulin may prevent serious cardiac problems." "Glucose will be administered concurrently to prevent hypoglycemia." "The insulin will reduce the toxins in your blood by lowering your metabolic rate."
"Insulin may prevent serious cardiac problems." "Glucose will be administered concurrently to prevent hypoglycemia." Hyperkalemia is one of the most lethal complications of acute kidney injury and can lead to life-threatening cardiac dysrhythmias. Insulin administration causes influx of potassium ions into the cells, thereby normalizing the potassium levels temporarily and preventing dysrhythmias. Glucose is administered simultaneously with insulin to prevent hypoglycemia in this intervention. Insulin does not decrease the levels of toxins, nor does it affect the kidney function.
The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? "The patient will have decreased potassium levels." "The patient will have increased urinary output." "The patient will have increased serum creatinine levels." "The patient will have decreased levels of blood urea nitrogen."
"The patient will have increased serum creatinine levels." Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste, and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium (hyperkalemia). The patient will experience a reduction in urine output. The patient will have an increased level of blood urea nitrogen.
Which is the most common intrarenal cause of acute kidney injury (AKI)? Bladder cancer Prostate cancer Acute glomerulonephritis Dehydration
Acute glomerulonephritis Kidney diseases, such as acute glomerulonephritis and systemic lupus erythematosus (SLE), are intrarenal causes of AKI. The damage from intrarenal causes usually results from prolonged ischemia, nephrotoxins (e.g., aminoglycoside antibiotics, contrast media), hemoglobin released from hemolyzed red blood cells (RBCs), or myoglobin released from necrotic muscle cells. Nephrotoxins can cause obstruction of intrarenal structures by crystallizing or causing damage to the epithelial cells of the tubules. Hemoglobin and myoglobin can block the tubules and cause renal vasoconstriction. Bladder cancer and prostate cancer are postrenal causes. Dehydration is a prerenal cause.
A patient presents to the emergency department with reports of shortness of breath and difficulty urinating. Upon review of test results, the nurse identifies that which is the best indicator of acute renal failure? Elevated serum creatinine levels Elevated serum blood urea nitrogen (BUN) Elevated serum pH on the arterial blood gases (ABGs) Hydronephrosis on the CT scan
Elevated serum creatinine levels The best indicator of level of renal functioning is the serum creatinine level. Elevated creatinine levels indicate renal failure. Hydronephrosis, or swelling of the kidney, may occur with obstructive processes such as renal calculi, but this is not an exclusive indicator of renal function. Elevated serum BUN levels may result from a variety of problems, including dehydration, severe injury, catabolic states, gastrointestinal (GI) bleeding, or renal failure. An elevated pH indicates acid-base imbalance, not necessarily renal failure.
The nurse planning care for a patient with acute kidney injury (AKI) recognizes that the interventions of highest priority are directly related to which nursing diagnosis? Ineffective coping Excess fluid volume Activity intolerance Imbalanced nutrition: less than body requirements
Excess fluid volume The issue of excess fluid volume is the primary problem of AKI and the highest priority for the nurse in this situation. When urine output decreases, fluid retention occurs. The severity of the manifestations depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended with a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure (HF), pulmonary edema, and pericardial and pleural effusions. The nursing diagnosis of ineffective coping is due to the acute severity of the illness. The nursing diagnosis of activity intolerance is related to the various AKI clinical manifestations. The nursing diagnosis of imbalanced nutrition, less than body requirements, is due to a decrease in appetite as a result of AKI.
The nursing student provides dietary education for a patient with acute kidney injury (AKI). The nurse intervenes when the student encourages the patient to increase the intake of which foods? Foods rich in fiber Foods rich in potassium Foods rich in calcium Foods rich in carbohydrates
Foods rich in potassium Hyperkalemia is a complication associated with acute kidney injury. Foods rich in potassium will further increase the potassium level in the blood; these foods should not be included in the patient's diet plan. Foods rich in fiber do not cause any harm to the patient's health and can be included. There are no contraindications for patient with AKI to consume foods high in calcium or foods rich in carbohydrates.
Which nursing interventions does the nurse include in the care plan of a patient with acute kidney injury? Select all that apply. Give thorough skin care. Wash the mouth frequently. Change the patient's position frequently. Encourage the patient to eat potassium-rich foods. Encourage the patient to drink plenty of fruit juices.
Give thorough skin care. Wash the mouth frequently. Change the patient's position frequently. Patients with kidney disease have an increased amount of ammonia in their saliva, which may cause mucosal irritation and inflammation. Therefore the nurse should wash the patient's mouth frequently. The nurse should give the patient good skin care to avoid scaly or dry skin. The nurse should frequently change the patient's position to prevent pressure ulcers. Renal impairment is associated with hyperkalemia; thus giving the patient potassium-rich foods may worsen the patient's condition and should not be included in the patient's care plan. The nurse should instruct the patient to restrict intake of fluid in the form of juices and water to prevent fluid overload and edema.
A patient with chronic kidney disease (CKD) experiences peripheral neuropathy, specifically asterixis. Which assessment finding does the nurse expect? Hand tremors while extending the wrist Burning sensation in the feet and legs Bilateral foot drop Muscle jerking
Hand tremors while extending the wrist Peripheral neuropathy initially manifests as a slowing of nerve conduction to the extremities. Asterixis is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterized by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist. The patient may describe a burning sensation in the feet and legs, which are paresthesias. Asterixis is not bilateral foot drop or muscle jerking.
Which is an intrarenal cause of acute kidney injury? Renal artery thrombosis Neuromuscular disorders Benign prostatic hyperplasia Hemolytic blood transfusion reaction
Hemolytic blood transfusion reaction Hemolytic blood transfusion reaction is an intrarenal cause of acute kidney injury. Renal artery thrombosis is a prerenal cause of acute kidney injury. Neuromuscular disorders and benign prostatic hyperplasia are postrenal causes of acute kidney injury.
The nurse monitors for which condition in patients with bilateral ureteral obstruction? Oliguria Benign prostatic hyperplasia Hydronephrosis Diabetic gastroparesis
Hydronephrosis Bilateral ureteral obstruction results in dilation of the kidneys, which is called hydronephrosis. Hydronephrosis, if left untreated, can result in acute kidney injury (AKI). Oliguria is associated with AKI, regardless of the etiology. Benign prostatic hyperplasia (BPH) is a postrenal cause of hydronephrosis and potentially AKI. Diabetic gastroparesis is a manifestation of chronic kidney disease.
Which clinical manifestation of acute kidney injury may cause changes in an electrocardiogram (ECG)? Hyperkalemia Fluid overload Hyponatremia Metabolic acidosis
Hyperkalemia Acute or rapid development of hyperkalemia affects the heart and causes ECG changes, such as peaked T waves, widening of the QRS complex, and ST-segment depression. Fluid overload may lead to pulmonary edema and heart failure. Uncontrolled hyponatremia may lead to the development of cerebral edema. Metabolic acidosis causes Kussmaul respirations.
A patient with acute kidney injury reports severe weakness and palpitations. The electrocardiogram (ECG) reveals widening of the QRS complex and an elevated T wave. Which complication does the nurse suspect? Hyperkalemia Hypercalcemia Hypernatremia Hyperchloremia
Hyperkalemia Hyperkalemia is associated with electrocardiographic changes like T-wave elevation, widening of the QRS complex, and ST-segment depression. A short QT interval and a small ST segment indicate hypercalcemia. Hypernatremia is characterized by a flat T wave. A depressed T wave is a characteristic of hyperchloremia.
Which assessment finding is a consequence of the oliguric phase of acute kidney injury (AKI)? Metabolic alkalosis Hyperkalemia Hypernatremia Thrombocytopenia
Hyperkalemia In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Impaired kidneys cannot excrete hydrogen ions or the acid products of metabolism. Serum bicarbonate (HCO 3) production decreases from defective reabsorption and regeneration of HCO 3 ions. The result is metabolic acidosis. Sodium levels are typically normal or diminished. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.
The nurse, reviewing the lab results of a patient with acute kidney injury, recognizes which finding as indicative of diminished renal function associated with the diagnosis? Hypokalemia; decreased ammonia level Increased serum urea; increased serum creatinine Anemia; decreased blood urea nitrogen (BUN) Increased serum albumin; increased potassium level
Increased serum urea; increased serum creatinine Renal failure, whether acute or chronic, causes an increase in serum urea, creatinine, and BUN. AKI causes an increased potassium level; ammonia levels are related to liver function. AKI may cause anemia; the BUN is increased. AKI does not cause increased serum albumin.
A patient presents with clinical manifestation of a long-term history of decreased urinary output and pedal edema. A diagnosis of chronic kidney failure is suspected. Which test will likely be necessary to provide a definitive diagnosis? Kidney biopsy Renal ultrasound Urinalysis Renal MRI
Kidney biopsy A kidney biopsy may be necessary to provide a definitive diagnosis. A renal ultrasound is usually done to detect any obstructions and determine the size of the kidneys. A urinalysis can detect red blood cells (RBCs), white blood cells (WBCs), protein, casts, and glucose. An MRI is not advised in patients with renal failure unless necessary due to the development of nephrogenic systemic fibrosis.
A patient's laboratory report reveals the glomerular filtration rate (GFR) is decreased by 75%. The nurse determines that the patient is experiencing which stage of acute kidney injury? Kidney injury Kidney failure Risk of kidney injury Loss of kidney function
Kidney failure The RIFLE (Risk, Injury, Failure, Loss, and End-stage) classification for staging of acute kidney injury utilizes percentages of loss of GFR to define stages of kidney injury. Kidney failure is defined by a GFR decrease by 75%. Kidney injury is defined by a GFR decrease by 50%. Risk of kidney injury is defined by a GFR decrease by 25%. Loss of kidney function is defined as complete loss of kidney function for greater than four weeks.
A patient reports reduced urine output and abdominal pain. The nurse suspects acute kidney injury and anticipates that which diagnostic test will be prescribed as an initial test to confirm the diagnosis? Renal biopsy Kidney ultrasound CT scan MRI
Kidney ultrasound Aside from blood tests, the health care provider will first order a kidney ultrasound because it does not involve exposure to contrast agents. A renal biopsy is the best method for confirmation of intrarenal causes of acute kidney injury; however, it is not the preliminary test used to diagnose acute kidney injury. A CT scan can identify lesions, masses, obstructions, and vascular anomalies, but it is not primarily used to establish a diagnosis of acute kidney injury. MRI will be suggested later to examine the abnormalities in detail.
Which condition is a result of severe metabolic acidosis in patients with acute kidney injury? Asterixis Proteinuria Hydronephrosis Kussmaul respirations
Kussmaul respirations Severe acidosis causes a patient to take deep and rapid breaths—called Kussmaul respirations—in an effort to increase the exhalation of carbon dioxide. Asterixis is a neurologic change associated with acute kidney injury due to the accumulation of metabolic waste in the brain and nervous system. Dysfunction of the glomerular membrane due to acute kidney injury leads to proteinuria. Hydronephrosis refers to dilation of the kidneys and is a postrenal cause of acute kidney injury.
The patient is diagnosed with acute kidney injury (AKI). The patient's history reveals weight gain and decreased urinary output. Which is the priority nursing intervention? Monitor the patient's cardiac status. Teach the patient about hand washing. Increase direct observation of the patient. Obtain a serum specimen for electrolytes every four hours.
Monitor the patient's cardiac status. The nurse's priority is to monitor the patient's cardiac status. In AKI, the serum potassium level increases because the kidney's normal ability to excrete potassium is impaired. The cardiac muscle is intolerant of acute increases in potassium. Acute or rapid development of hyperkalemia may result in life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as prescribed by the health care provider, and the frequency depends on the serum levels, response to treatments, clinical manifestations, and other factors.
Which is a clinical manifestation of acute kidney injury? Oliguria Uremia Anemia Pruritus
Oliguria Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury.
A patient, hospitalized with a pulmonary embolism, has a three-day history of decreased cardiac output and hypotension. The nurse identifies that the patient is at risk for which renal complication? Chronic kidney disease Acute glomerulonephritis Renal calculi Prerenal acute kidney injury (AKI)
Prerenal acute kidney injury (AKI) Prerenal causes of AKI are factors that reduce systemic circulation, causing a reduction in renal blood flow. The decrease in blood flow leads to decreased glomerular perfusion and filtration of the kidneys. In prerenal oliguria, there is no damage to the kidney tissue (parenchyma). The oliguria is caused by a decrease in circulating blood volume (e.g., severe dehydration, heart failure [HF], decreased cardiac output). An acute period of decreased blood volume does not put the patient at risk for chronic kidney disease. The decrease in blood flow would not cause acute glomerulonephritis or renal calculi.
The nurse provides education for a group of nursing students about prerenal causes of acute kidney injury and includes which information? Parenchymal damage occurs in prerenal oliguria. Prerenal azotemia results in increased sodium excretion. Prerenal oliguria is caused by decreased circulatory volume. Prerenal causes of acute kidney injury increase the glomerular filtration rate.
Prerenal oliguria is caused by decreased circulatory volume. Prerenal oliguria is caused by a decrease in the circulatory volume due to dehydration and congestive cardiac failure. Parenchymal damage does not occur in prerenal oliguria. Prerenal azotemia results in decreased sodium excretion, which leads to increased sodium and water retention. Reduced systemic circulation is a prerenal cause that leads to a decrease in the blood flow to the kidneys. Therefore the glomerular filtration rate also decreases.
A patient with kidney disease is scheduled for a diagnostic study in which contrast media will be used. Which intervention does the nurse implement? Give low-fat foods Give low-calorie foods Provide plenty of fluids Provide a high-protein diet
Provide plenty of fluids In patients with kidney disease, contrast-induced nephropathy (CIN) can occur when contrast media for diagnostic studies causes nephrotoxic injury. If contrast media must be given to a high-risk patient, the patient needs to have optimal hydration and the lowest possible dose of the contrast agent. Nursing interventions to ensure adequate fluid intake and hydration can decrease the risks associated with contrast media. Fatty foods are rich in calories and should be given to provide energy. High-calorie foods should be included in a patient's diet. A high-protein diet causes increased levels of nitrogenous waste in the blood. Therefore a low-protein diet should be given to this patient.
A patient with kidney failure experiences three episodes of vomiting and diarrhea. Which priority action does the nurse take? Administer an antiemetic. Record the BP. Record the volume of fluid lost. Administer water with a high salt content.
Record the volume of fluid lost. The nurse should record the volume of fluid lost as a priority because replacement must be done to prevent tubular damage. The nurse should not administer drugs without consulting the health care provider. The BP should be recorded to check for hypovolemia, but this action can also be performed later. The nurse should not administer salty water because it can induce vomiting.
Which event is a cause of prerenal acute kidney injury? Release of nephrotoxins Reduced renal blood flow Urine reflux into renal pelvis Formation of calculi
Reduced renal blood flow Prerenal acute kidney injury can be caused by a reduced flow of blood to the kidneys. A release of nephrotoxins is an intrarenal cause of acute kidney injury. Urine reflux into the renal pelvis and the formation of calculi are postrenal causes of acute kidney injury.
The nurse identifies that a patient is in the oliguric phase of acute kidney injury (AKI) based on which assessment finding? Decreased urine output within 12 hours of the injury to the kidneys Reduced urine output to less than 400 mL/day Decreased blood urea nitrogen (BUN) level Below-normal levels of serum creatinine
Reduced urine output to less than 400 mL/day The most common initial manifestation of AKI is oliguria, a reduction in urine output to less than 400 mL/day. Oliguria usually occurs within one to seven days of the injury to the kidneys. The kidneys are the primary excretory organs for urea (an end product of protein metabolism) and creatinine (an end product of endogenous muscle metabolism). BUN and serum creatinine levels are increased in kidney disease.
Which are postrenal causes of acute kidney injury? Select all that apply. Renal calculi Spinal cord disease Benign hypertrophic hyperplasia (BPH) Kidney ischemia Myoglobin release
Renal calculi Spinal cord disease Benign hypertrophic hyperplasia (BPH) Renal calculi, spinal cord disease, and BPH are postrenal causes of acute kidney injury. Intrarenal causes of acute kidney injury include kidney ischemia and myoglobin released from muscle cells.
When caring for a patient during the oliguric phase of acute kidney injury (AKI), which is an appropriate nursing intervention? Weigh patient three times weekly. Increase dietary sodium and potassium. Provide a low-protein, high-carbohydrate diet. Restrict fluids according to previous daily loss.
Restrict fluids according to previous daily loss. Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore they will need to have dietary sodium, potassium, and fluids restricted. The patient also should be weighed daily, not just three times each week. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism.
A patient with acute kidney injury is prescribed IV insulin and IV glucose. Which is the purpose of administering both insulin and dextrose? To treat hyperkalemia with insulin and prevent hypoglycemia with glucose To manage hyperglycemia with insulin and prevent hypoglycemia with glucose To prevent metabolic acidosis with insulin and restore metabolic activity with glucose To promote renal absorption of sodium with glucose and to prevent hyponatremia with insulin
To treat hyperkalemia with insulin and prevent hypoglycemia with glucose The purpose of administering insulin and dextrose is to lower the serum potassium level. Insulin works by pushing the potassium back into the cells, and glucose prevents hypoglycemia. Hyperglycemia may be managed with insulin but not dextrose simultaneously. Insulin does not prevent metabolic acidosis, nor does glucose restore metabolic activity. Glucose does not promote renal absorption of sodium, and insulin does not prevent hyponatremia.
The nurse determines that a patient is experiencing oliguria based on which amount of urinary output? Urinary output of 350 mL/day Urinary output of 450 mL/day Urinary output of 550 mL/day Urinary output of 650 mL/day
Urinary output of 350 mL/day A urinary output rate of less than 400 mL/day indicates oliguria; thus, a urinary output of 350 mL/day suggests oliguria. Urine outputs of 450, 550, or 650 mL/day are considered normal.
Which finding corresponds with nonoliguric acute kidney injury (AKI)? Urinary output of 150 mL/day Urinary output of 250 mL/day Urinary output of 350 mL/day Urinary output of 450 mL/day
Urinary output of 450 mL/day Nonoliguric AKI has a urine output greater than 400 mL/day. About 50% of patients with AKI will be nonoliguric, making the initial diagnosis more difficult. A urine output of less than 400 mL/day indicates oliguric AKI.
A nursing student asks the nurse how continuous renal replacement therapy (CRRT) is different than hemodialysis (HD). Which information does the nurse provide? The blood pump in CRRT runs at a faster rate. CRRT is intermittent rather than continuous. With CRRT, fluid volume can be removed over three to four hours versus days. With CRRT, no dialysate is required for solute removal.
With CRRT, no dialysate is required for solute removal. Several features of CRRT differ from HD. Solute removal can occur by convection (no dialysate required) in addition to osmosis and diffusion. The blood pump in CRRT runs at a slower (150 mL/min average) rate. It is continuous rather than intermittent. Fluid volume can be removed over days (24 hours to more than two weeks) versus hours (three to four hours).