Acute Kidney Injury (AKI)

A client diagnosed with acute kidney injury (AKI) will be discharged to home in the next few days. When conducting dietary instruction, the nurse should teach the client to choose proteins that are high in biological value. Which client statement indicates that this teaching has been effective? A) "I will be sure to include eggs in my diet." B) "I should include vegetables at every meal." C) "Legumes should be included in my diet, because they are complete proteins." D) "I will eat nuts daily because they are high in protein."

A) "I will be sure to include eggs in my diet." Rationale: Eggs are an excellent source of essential amino acids and are recommended as part of the diet for a client with acute kidney injury (AKI) who is on a protein-restricted diet. Legumes, nuts, and vegetables do contain protein, but they are incomplete proteins and thus not as good a protein source as eggs.

A client is being discharged following the placement of an AV fistula. The nurse is providing discharge instructions to the client regarding the fistula. Which should the nurse share during this session? A) "The fistula will not be functional for dialysis for a month." B) "The fistula will heal within a week." C) "This fistula is created by joining two arteries together." D) "This is temporary access for dialysis."

A) "The fistula will not be functional for dialysis for a month." Rationale: For​ longer-term vascular​ access, an arteriovenous​ (AV) fistula​ (an artificial connection between a vein and an​ artery) is created. In preparation for fistula​ formation, the nondominant arm is not used for venipuncture or blood pressure measurement during renal failure. The fistula is created by surgical anastomosis of an artery and​ vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used.

The nurse is discussing medications with a client with AKI upon discharge. Which should be included in the teaching? A) Avoid taking NSAIDs B) Avoid taking iron supplementation C) Avoid taking Acetaminophen (Tylenol) D) Avoid taking blood pressure meds at night

A) Avoid taking NSAIDs Rationale: All drugs that either are directly nephrotoxic or may interfere with renal perfusion​ (e.g., potent​ vasoconstrictors) should be avoided.​ NSAIDs, nephrotoxic​ antibiotics, and other potentially harmful drugs are avoided throughout the course of AKI. Iron supplementation can be continued if the client is not receiving the required amount in the foods they consume. Acetaminophen can be taken for​ discomfort, as it does not contain the same chemical​ make-up as the NSAIDS. The client should take their blood pressure medication as ordered by the healthcare provider.

The nurse is caring for a critically-ill client who experienced significant blood loss during surgery. Which concern related to the client's risk for pre-renal AKI should the nurse consider the priority? A) Diminished cardiac output B) Urinary obstruction C) Hyperperfusion D) Fluid overload

A) Diminished cardiac output Rationale: 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. Prerenal AKI is​ common, particularly in clients who experience trauma or surgery or are critically ill. The kidneys normally receive 20-​25% of the cardiac output to maintain the glomerular filtration rate​ (GFR), the rate at which fluid is filtered through the kidneys. A drop in renal blood flow to less than​ 20% of normal causes the GFR to fall.​ Hypoperfusion, not​ hyperperfusion, would be a concern. Obstruction is a concern with postrenal​ AKI, not prerenal. Dehydration due to fluid loss would be the​ concern, not fluid overload

Which symptom suggests that a client is entering the maintenance phase of acute kidney injury (AKI)? A) Onset of metabolic acidosis B) Onset of diuresis C) Increase in glomerular filtration rate D) Decrease in serum potassium levels

A) Onset of metabolic acidosis Rationale: The maintenance phase of AKI is characterized by a significant fall in glomerular filtration rate (GFR) and tubular necrosis. Oliguria, azotemia, fluid retention, electrolyte imbalances, and metabolic acidosis may all develop. Also during this phase, impaired potassium excretion leads to hyperkalemia, or increased serum potassium levels. Onset of diuresis and an increasing glomerular filtration rate are suggestive of the recovery phase, not the maintenance phase.

The nurse is planning care for a client diagnosed with acute kidney injury (AKI). The nurse plans the client's care based on the nursing diagnosis of Excess Fluid Volume. Which assessment data supports this nursing diagnosis? A) Pitting edema in the lower extremities B) Bowel sounds positive in four quadrants C) Wheezing in the lungs D) Generalized weakness

A) Pitting edema in the lower extremities Rationale: The client in acute kidney injury (AKI) will likely be edematous, because the kidneys are not producing urine. Wheezing in the lungs is an assessment consistent with asthma, not AKI. Bowel sounds in four quadrants is a normal assessment finding. Generalized weakness may be due to whatever disease process precipitated the kidney failure

A client with acute kidney failure is complaining of a metallic taste in the mouth and has no appetite. Based on this data, which intervention by the nurse is the most appropriate? A) Provide mouth care before meals. B) Administer an antiemetic as prescribed. C) Restrict fluids. D) Encourage the intake of protein, salt, and potassium.

A) Provide mouth are before meals Rationale: A metallic taste in the mouth is due to uremia. The nurse should provide mouth care before meals to reduce this taste sensation and improve the client's oral intake. An antiemetic would be prescribed for nausea. Restricting fluids would not reduce the metallic taste in the mouth. Encouraging intake of protein, salt, and potassium would exacerbate the uremia that is causing the metallic taste in the mouth.

The nurse notes that the plan of care for a client with AKI instructs them to reposition the client every 2 hours while in bed. Which is the rationale behind this instruction? A) To avoid skin breakdown B) To keep the client awake C) To keep skin dry D) To avoid bone fractures

A) To avoid skin breakdown Rationale: Turning the client frequently and providing good skin care help to avoid skin breakdown. Edema decreases tissue perfusion and increases the risk of skin​ breakdown, especially in clients who are older or debilitated. Frequent repositioning has no bearing on bone fractures. The client should be kept dry to assist in avoiding skin breakdown. Repositioning is not done to disturb or keep the client awake.

The nurse is caring for a client diagnosed with acute kidney injury (AKI). When reviewing the client's laboratory data, which findings should indicate to the nurse that the client has met the expected outcomes? Select all that apply. A) Decreasing serum creatinine B) Decreasing blood urea nitrogen (BUN) C) Decreasing neutrophil count D) Decreasing lymphocyte count E) Decreasing erythrocyte count

A, B Rationale: - Decreasing CREA, BUN Rationale: Creatinine is the metabolic end product of creatine phosphate and is excreted via the kidneys in relatively constant amounts. BUN, a measurement of the nitrogen portion of urea, is also excreted in urine and is a good indicator of renal function. Neutrophils, lymphocytes, and erythrocytes are not used to monitor the return of renal function.

The nurse is concerned that an older adult client is at risk for developing acute kidney injury (AKI). Which data in the client's history supports the nurse's concern? SATA A) Diagnosed with hypotension B) Recent aortic valve replacement surgery C) Prescribed high doses of intravenous antibiotics D) Total hip replacement surgery 5 years ago E) Taking medication for type 2 diabetes mellitus

A, B, C Rationale: Older adults develop acute kidney injury more frequently because of the higher incidence of serious illnesses, hypotension, major surgeries, diagnostic procedures, and treatment with nephrotoxic drugs. Decreased kidney function associated with aging also puts the older client at risk for acute kidney injury. Hypotension, aortic valve replacement surgery, and receipt of high doses of intravenous antibiotics increase this client's risk for developing acute kidney injury. A previous history of hip replacement surgery and current treatment for type 2 diabetes mellitus are not identified risk factors for the development of acute kidney injury.

The nurse preceptor is teaching a new graduate about conditions that can cause damage to the renal parenchyma and nephrons resulting in AKI. Which condition should the nurse preceptor include? SATA A) Vasculitis B) Hypertension C) Hemodialysis D) Glomerulonephritis E) Dehydration

A, B, C, D -Vasculitis - HTN - Hemolysis - Glomerulonephritis Rationale: Hypertension,​ hemolysis, glomerulonephritis, and vasculitis cause acute damage to the renal parenchyma and​ nephrons, leading to intrarenal AKI. Dehydration causes prerenal AKI and does not cause damage to the renal parenchyma and nephrons.

*Possible exam question* A client diagnosed with AKI is experiencing hyperkalemia. Which medication should the nurse anticipate being prescribed to this client? SATA A) Calcium chloride B) Insulin C) Glucose D) Angiotensin-converting enzyme (ACE) inhibitors E) Sodium bicarbonate

A, B, C, E Rationale: The nurse should anticipate that calcium​ chloride, sodium​ bicarbonate, insulin, and glucose would be prescribed to treat the​ client's hyperkalemia. Calcium​ chloride, sodium​ bicarbonate, and insulin can be used to reduce serum potassium levels by moving potassium into the cells. Calcium is also administered to correct hypocalcemia and reduce hyperphosphatemia.​ (Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other​ falls.) An ACE inhibitor is used to treat​ hypertension, not hyperkalemia.

The nurse is completing a health hx on a client admitted with acute renal failure. Which information should the nurse collect? SATA A) Recent exposure to nephrotoxic medications B) Chronic diseases C) Previous transfusion reactions D) Reports of weight loss E) Reports of anorexia

A, B, C, E Rationale: When completing a health history on a client with acute renal​ failure, the nurse needs to collect information on recent exposure to nephrotoxic medications​ (e.g., nonsteroidal​ anti-inflammatory drugs​ [NSAIDs] and some chemotherapeutic​ drugs); previous transfusion​ reactions; chronic diseases such as diabetes​ mellitus, heart​ failure, and kidney​ disease; and reports of anorexia. The nurse needs to collect information on reports of weight​ gain, not weight loss.

*Kind of shit question alert* A nurse is caring for a pregnant woman. Which physiologic condition may occur during pregnancy and is related to the development of AKI that should concern the nurse? SATA A) Hydronephrosis B) Hyperemesis gravidarum C) Hypertension D) Preeclampsia E) Hypoglycemia

A, B, D -Hydronephrosis - Hyperemesis gravidarum - Preeclampsia Rationale: During​ pregnancy, glomerular filtration rate increases​ significantly, perhaps by as much as​ 50%. This leads to a decrease in baseline serum creatinine and other changes associated with the increased blood volume that pregnancy brings. AKI in pregnant women is often related to the same etiologies as are identified in the general population.​ However, there are unique etiologies that manifest themselves throughout the pregnancy cycle. Over​ 90% of women develop a physiologic hydronephrosis of​ pregnancy, and this can promote urinary​ stasis, lead to urinary tract​ infection, and ultimately lead to AKI. In​ addition, in the first​ trimester, hyperemesis gravidarum and placenta previa may lead to​ AKI, and as pregnancy​ progresses, pregnancy-induced​ hypertension, preeclampsia, and eclampsia stress the​ kidneys, leading to​ proteinuria, hydronephrosis, and AKI.

The nurse is caring for a client with AKI. Which condition should the nurse recognize as a possible cause for this disease? SATA A) Severe heart failure B) Major trauma C) Cerebrovascular disease D) Radiologic contrast media E) Hemorrhage

A, B, D, E Rationale: Major​ trauma, heart​ failure, and hemorrhage are all possible risks and causes for AKI because they can reduce blood flow to the kidneys. Radiologic contrast media can be nephrotoxic and cause AKI. Cerebrovascular disease is not a risk factor for AKI because it does not reduce blood flow to the kidneys and it does not cause nephrotoxicity.

A client diagnosed with frequent urinary tract infections is seen in the urology clinic. The nurse reviews the client's medical history and determines that the client is at risk for acute kidney injury. Which items in the client's history support this conclusion? Select all that apply. A) Dehydration B) Renal calculi C) Ineffective wound healing D) Low serum albumin E) Hypertension

A, B, E -Dehydration - Renal calculi - HTN Rationale: Dehydration, renal calculi, and hypertension can all precipitate acute kidney injury (AKI). Ineffective wound healing has not been shown to cause renal failure unless the infection becomes systemic. A low serum albumin does not cause AKI.

The nurse describes the increased risk of GI bleeding to a client with AKI. Which factor should the nurse inform the client with regard to medication? SATA A) "Avoid magnesium-based antacids." B) "Drink milk to coat the stomach prior to taking medication." C) "OTC calcium carbonate (Tums) is helpful." D) "Regular doses of antacids are indicated." E) "Take antacids at bedtime."

A, D Rationale: The client with AKI has an increased risk of GI​ bleeding, probably related to the stress response and impaired platelet function. Regular doses of antacids​ (although not ones that are magnesium​ based), histamine​ H2-receptor antagonists​ (e.g., famotidine,​ ranitidine), or a proton pump inhibitor​ (e.g., omeprazole​ [Prilosec]) are often ordered to prevent GI hemorrhage. All​ medications, including​ over-the-counter medications, should be discussed with the healthcare provider to see if they are contraindicated in their medical condition. Milk will not coat the stomach or protect the gastric mucosa.

The community nurse visits the home of a young child who is home from school because of sudden onset of nausea, vomiting, and lethargy. The nurse suspects acute kidney injury (AKI). Which clinical manifestations support the nurse's suspicions? SATA A) Elevated blood pressure B) Postural hypotension C) Wheezing D) Edema E) Hematuria

A, D, E - Elevated BP, Edema, Hematuria Rationale: Pediatric manifestations of acute kidney injury characteristically begin with a healthy child who suddenly becomes ill with nonspecific symptoms that indicate a significant illness or injury. These symptoms may include any combination of the following: nausea, vomiting, lethargy, edema, gross hematuria, oliguria, and hypertension. Postural hypotension is a manifestation of acute kidney injury in an older person. Wheezing is not a manifestation of acute kidney injury.

The nurse is caring for a client admitted with a diagnosis of acute kidney injury (AKI). The client asks the nurse, "Are my kidneys failing? Will I need a kidney transplant?" Which response by the nurse is the most appropriate? A) "No, don't think that. You're going to be fine." B) "In most cases, your condition can be reversed with prompt treatment and usually will not destroy the kidneys." C) "Kidney transplantation is highly likely, so it would be a good idea to start talking to your family members about organ donation." D) "When the doctor comes to see you, we can talk about whether you will need a transplant."

B) "In most cases, your condition can be reversed with prompt treatment and usually will not destroy the kidneys." Rationale: Acute kidney injury (AKI) is often resolved without the need for transplant if treatment is initiated quickly. There is no need to start lining up donors or wait for the provider to arrive to explore options. Telling the client that everything will be fine is condescending, provides no information, and is not within the nurse's ability to know.

A​ 63-year-old man is admitted with postrenal acute kidney injury​ (AKI) because of a kidney stone. Vascular volume and renal perfusion have been restored and he is on fluid restriction. During the past 24​ hours, he has voided 250 mL of urine. He has not had any other type of output. How much fluid should the client receive over the next 24​ hours? A) 1250 mL B) 750 mL C) 3000 mL D) 2750 mL

B) 750 mL Rationale: Once vascular and renal perfusion has been​ restored, fluid intake for clients with AKI is usually restricted because the kidneys cannot eliminate fluids normally. Fluid intake is calculated for these clients by adding the amount of output for the previous 24 hours to 500 mL to allow for insensible losses. The​ client's output for the past 24 hours was 250​ mL; added to 500​ mL, the fluid volume calculation equals 750 mL. A fluid intake of​ 1250, 2750, or 3000 mL would be too much fluid for the client and would put the client at risk for fluid overload.

The nurse is treating a client with a potassium level of 6.7 who is already on restricted potassium intake. Which medication may be ordered to reduce the neuromuscular effects of this increased level? A) H2-receptor antagonist B) Calcium chloride C) Antibiotic D) Lactated Ringer

B) Calcium chloride Rationale: Hyperkalemia may require active intervention as well as restricted potassium intake. When the serum potassium level is greater than 6.0-6.5 ​mEq/L, manifestations of its effect on neuromuscular function​ develop, including muscle​ weakness, nausea and​ diarrhea, electrocardiographic​ changes, and possible cardiac arrest. With significant​ hyperkalemia, calcium​ chloride, bicarbonate, and insulin and glucose may be given intravenously to reduce serum potassium levels by moving potassium into the cells. An​ H2-receptor antagonist helps prevent gastrointestinal hemorrhage by decreasing gastric acid production. An antibiotic would be used to treat infection. Lactated Ringer would be used in children with AKI for fluid replacement.

A client diagnosed with acute kidney injury (AKI) has jugular vein distention, lower extremity edema, and elevated blood pressure. Based on this data, which nursing diagnosis is most appropriate? A) Ineffective Renal Tissue Perfusion B) Excess Fluid Volume C) Risk for Decreased Cardiac Tissue Perfusion D) Risk for Infection

B) Excess Fluid Volume Rationale: Jugular vein distention, edema, and elevated blood pressure are all indications of excess fluid. Thus, the diagnosis Excess Fluid Volume should be selected to guide this client's care. Oliguria or reduced urine output would be a symptom associated with Ineffective Renal Tissue Perfusion. Alterations in heart rate and rhythm would be symptoms associated with Risk for Decreased Cardiac Tissue Perfusion. The client is not demonstrating any manifestations that indicate a Risk for Infection.

*Possible exam question* What is the most frequent complication during hemodialysis? A) Hemorrhage B) Hypotension C) Localized infection D) Hypertension

B) Hypotension Rationale: Hypotension is the most frequent complication during hemodialysis. It may result from changes in serum osmolality, rapid removal of fluid from the vascular compartment, vasodilation, and other factors. Bleeding is another possible complication, although it does not occur as often as hypotension. Infection is also commonly associated with hemodialysis, although it occurs following treatment rather than during dialysis.

The nurse is discussing management of AKI with the client. Which would describe the key goal to managing this condition? A) Avoiding the use of diuretics B) Maintaining fluid and electrolyte balance C) Drinking more fluids D) Eating more vegetable that are low in iron

B) Maintaining fluid and electrolyte balance Rationale: If a client develops​ AKI, maintaining the fluid and electrolyte balance is a key goal in managing the condition. Drinking more fluids could place the client at risk for fluid overload. Diuretics may be ordered for a client who is retaining a significant amount of fluid. Increasing the amount of iron in the diet is necessary if the client is not getting the daily requirement in the foods they are consuming

*Possible exam question* Which laboratory finding suggests that a client is experiencing acute kidney injury (AKI) as a result of glomerular damage? A) Hyperkalemia B) Proteinuria C) Urine specific gravity of 1.010 D) Moderate anemia

B) Proteinuria Rationale: Proteinuria, or excess protein in the urine, is suggestive of glomerular damage as the cause of a client's AKI. Urine specific gravity of 1.010, moderate anemia, and hyperkalemia are common laboratory findings in clients with AKI, regardless of its cause.

The nurse is providing discharge instructions to a client going home on 80 mg of furosemide (Lasix), a loop diuretic, twice a day. Which teaching should be included in these instructions? SATA A) "Do not take at the same time as other medications." B) "Rise slowly from lying or sitting position." C) "Avoid using NSAIDs." D) "Take with water only." E) "Take in the morning and at bedtime."

B, C Rationale: Teaching for the client and the family of the client who is prescribed furosemide includes the​ following: • Unless​ contraindicated, maintain a fluid intake of 2 to 3​ L/day. • Rise slowly from lying or sitting positions because a fall in blood pressure may cause lightheadedness. • Take it in the morning​ and, if ordered twice a​ day, in the late afternoon to avoid sleep disturbance. • Take it with food or milk to prevent gastric distress. • NSAIDs interfere with the effectiveness of loop diuretics and should be avoided.

Which data should the nurse collect when completing a physical examination on a client experiencing AKI? SATA A) Reports of edema B) Weight C) Lung sounds D) Skin color E) Hx of diabetes

B, C, D Rationale: When completing a physical examination on a client experiencing acute renal​ failure, the nurse needs to note the​ client's weight, skin​ color, and lung​ sounds, which may indicate fluid volume excess. Reports of edema and having a history of diabetes mellitus are information collected when obtaining a​ client's health history.

The nurse is reviewing discharge instructions with a client with AKI. Which diet instruction should the nurse include? SATA A) Eat foods high in potassium B) Eat low-phosphorous foods C) Eat foods low in potassium D) Eat foods low in saturated fat E) Eat high-calcium foods

B, C, D, E - low phos - low K+ - low sat fat - high calcium Rationale: Clients with AKI experience electrolyte imbalances. The client with AKI is at particular risk for hyperkalemia caused by impaired potassium excretion and hyperphosphatemia. Calcium and phosphate have a reciprocal relationship in the​ body; as the level of one​ rises, the level of the other falls.​ Therefore, the client should eat foods high in calcium and low in phosphate. Saturated fats are known to raise the levels of cholesterol and therefore should be eaten in moderation.

*Possible exam question* A client diagnosed with acute kidney injury (AKI) is receiving peritoneal dialysis. The nurse is explaining the dialysis process to the client and family. Which statement should the nurse include in this discussion? A) "The peritoneum is more permeable because of the presence of excess metabolites." B) "The metabolites will diffuse from the interstitial space to the bloodstream mainly through diffusion and ultrafiltration." C) "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." D) "The solutes in the dialysate will enter the bloodstream through the peritoneum."

C) "The peritoneum acts as a semipermeable membrane through which wastes move by diffusion and osmosis." Rationale: The peritoneum acts as a semipermeable membrane, allowing substances to move from an area of high concentration (the blood) to an area of lower concentration (the dialysate). Metabolic waste products and excess water can be eliminated through osmosis and diffusion using the peritoneum as the semipermeable membrane.

The nurse is describing to a colleague how the accumulation of metabolites in the blood from renal failure affects the body. Which effect should the nurse include? A) Bradycardia B) Increased pain C) Altered electrolyte balance D) Decreased levels of nitrogenous wastes in blood

C) Altered electrolyte balance Rationale: Renal failure is a condition in which the kidneys are unable to remove accumulated metabolites from the​ blood, resulting in altered fluid and electrolyte balance and acid-base balance. Increased pain in a client with renal failure would not cause an alteration in the amount of metabolites. Heart palpitations are caused by​ stress, physical​ exertion, too much​ caffeine, and the use of stimulants. Decreased blood volume is usually caused by bleeding or dehydration.

A client diagnosed with recurrent urinary tract calculi would be at elevated risk for which of the following types of acute kidney injury (AKI)? A) Prerenal AKI B) Intrinsic AKI C) Postrenal AKI D) Intrarenal AKI

C) Postrenal AKI Rationale: Obstructive causes of AKI are classified as postrenal. Any condition that prevents urine excretion—including urinary tract calculi—can lead to postrenal AKI. In comparison, prerenal AKI results from conditions that affect renal blood flow and perfusion, and intrinsic AKI (also called intrarenal AKI) is characterized by acute damage to the renal parenchyma and nephrons.

For which reason did the nurse place a chair scale in the room of a client who has been admitted with AKI? SATA A) Because chair scales are the most accurate B) Limited availability of equipment C) To ensure an accurate weight D) Because equipment calibration can vary E) To utilize standard technique

C, D, E Rationale: Weigh the client daily or more frequently as ordered. Use standard technique​ (same scale,​ clothing, or​ coverings) to ensure accuracy. Rapid weight changes are an accurate indicator of fluid volume​ status, particularly in the client with oliguria. Any drastic shift in weight of a client with AKI indicates some malfunction and can adversely affect other organs and the treatment program.

A young school-age client is in the hospital with an acute kidney injury diagnosis following a streptococcus infection. The client's parents primarily speak Spanish but have a limited ability to understand English. Through an interpreter, the parents ask the nurse what mistake they made that caused their child to be so sick. Which response by the nurse is the most appropriate? A) "Your child does not eat enough dietary protein." B) "Your child has a congenital defect that led to renal failure." C) "Your child's renal failure has been caused by a low calcium level." D) "Your child's recent infection may have caused the renal failure."

D) "Your child's recent infection may have caused the renal failure." Rationale: Clients with streptococcus are at risk for kidney and cardiac sequelae. In this case, the child has no evidence of a congenital defect leading to acute kidney injury (AKI). A low-protein or low-calcium diet will not lead to AKI.

*Possible exam question* Which medication is used to increase renal blood flow in clients with acute kidney injury? A) Furosemide (Lasix) B) Mannitol (Osmitrol) C) Bumetanide (Bumex) D) Dopamine (Intropin)

D) Dopamine Rationale: In clients with acute kidney injury, dopamine (Intropin) is administered in low doses by intravenous infusion to increase renal blood flow. If restoration of renal blood flow does not improve urinary output, a potent loop diuretic, such as furosemide (Lasix) or bumetanide (Bumex), or an osmotic diuretic, such as mannitol (Osmitrol), may be given with intravenous fluids. These medications help "wash" nephrotoxins out of the kidneys and reestablish urine output.

A client experiencing hyperkalemia is scheduled for dialysis. The nurse anticipates an order for insulin to help lower the serum potassium level. Which beneficial action does this medication have for this client? A) Acts as an anticoagulant B) Pulls fluid from the cells C) Lowers the blood glucose rate D) Drives the potassium back into the cells

D) Drives the potassium back into the cells Rationale: Glucose and insulin are administered to the client with hyperkalemia to help drive potassium back into the intracellular​ fluid, reducing the amount of potassium in the blood. Potassium supplements would only increase the​ client's potassium levels. Insulin is used to control the blood glucose rate in a diabetic client. Insulin is not known to draw fluid from the cells or act as an anticoagulant.

*Possible exam question* A client agrees to receive long-term hemodialysis to treat acute kidney injury (AKI). Based on this information, the nurse should prepare the client for which surgical procedure? A) Insertion of a double-lumen catheter into the subclavian artery B) Placement of a peritoneal catheter C) Insertion of a subarachnoid-peritoneal shunt D) Placement of an arteriovenous fistula

D) Placement of an arteriovenous fistula Rationale: For long-term vascular access needed for hemodialysis, an arteriovenous (AV) fistula is created. The fistula is created by surgical anastomosis of an artery and vein, usually the radial artery and cephalic vein. It takes about a month for the fistula to mature so that it can be used for taking and replacing blood during dialysis. A double-lumen catheter inserted into a major artery is used as temporary vascular access for continuous renal replacement therapy. A peritoneal catheter is used for peritoneal dialysis, not hemodialysis. A subarachnoid-peritoneal shunt is used to remove excess cerebrospinal fluid and not for hemodialysis.

The nurse is planning care for a client admitted with a diagnosis of heart failure. Based on this diagnosis, which type of kidney failure is the client at an increased risk for experiencing? A) Prerenal hypovolemia B) Intrarenal glomerular injury C) Intrarenal acute tubular necrosis D) Prerenal low cardiac output

D) Prerenal low cardiac output Rationale: Heart failure is one possible cause of prerenal kidney failure due to low cardiac output. In comparison, causes of prerenal kidney failure due to hypovolemia include hemorrhage, dehydration, burns, wounds, and excess fluid loss from the gastrointestinal tract. Causes of intrarenal kidney failure due to glomerular injury include glomerulonephritis, disseminated intravascular coagulation, vasculitis, hypertension, toxemia of pregnancy, and hemolytic uremic syndrome. Finally, causes of intrarenal kidney failure due to acute tubular necrosis include ischemia resulting from conditions associated with prerenal failure, toxins, hemolysis, and rhabdomyolysis.

The nurse is explaining to the client the most common causes of AKI. Which cause should the nurse present? SATA A) Fluid overload B) Dehydration C) Chemical imbalance D) Insufficient blood supply E) Exposure to nephrotoxins

D, E - Insufficient blood supply - Exposure to nephrotoxins Rationale: The most common causes of acute kidney injury​ (AKI) are ischemia​ (insufficient blood​ supply) and exposure to nephrotoxins​ (substances that damage nerves or nerve​ tissue). Because of the amount of blood that passes through​ them, the kidneys are particularly vulnerable to these factors. A fall in blood pressure or volume can cause ischemia of kidney tissues. Nephrotoxins in the blood damage renal tissue directly. Other causes of AKI include major​ surgery, sepsis, and severe pneumonia.