CH18 Kidney Clinical Assessment and Diagnostic Procedures

15. A patient was admitted with acute heart failure. The nurse is assessing the patient for peripheral edema. The nurse presses two fingers over the tibial area, and it takes 1 minute before the indention disappears. What would the nurse in the medical record? · +1 pitting edema · +2 pitting edema · +3 pitting edema · +4 pitting edema

· +3 pitting edema -3+ 𝘱𝘪𝘵𝘵𝘪𝘯𝘨 𝘦𝘥𝘦𝘮𝘢 = 6-𝘮𝘮 𝘥𝘦𝘱𝘵𝘩 (𝘭𝘢𝘴𝘵𝘪𝘯𝘨 𝘶𝘱 𝘵𝘰 60 𝘴) -𝘗𝘪𝘵𝘵𝘪𝘯𝘨 𝘌𝘥𝘦𝘮𝘢 𝘚𝘤𝘢𝘭𝘦, 𝘛𝘢𝘣𝘭𝘦 18.1 (332). -𝘢𝘯𝘺 𝘭𝘰𝘯𝘨𝘦𝘳 𝘵𝘩𝘢𝘯 1 𝘮𝘪𝘯𝘶𝘵𝘦 𝘸𝘰𝘶𝘭𝘥 𝘣𝘦 𝘤𝘰𝘯𝘴𝘪𝘥𝘦𝘳𝘦𝘥 4+ 𝘱𝘪𝘵𝘵𝘪𝘯𝘨

12. A patient is admitted with acute kidney injury. The patient's weight upon admission was 176 lb and the next day it is 184 lb. What is the approximate amount of fluid retained with this weight gain? · 800 mL · 2200 mL · 3600 mL · 8000 mL

· 3600 mL -𝘙𝘢𝘱𝘪𝘥 𝘸𝘦𝘪𝘨𝘩𝘵 𝘨𝘢𝘪𝘯𝘴 𝘰𝘳 𝘭𝘰𝘴𝘴𝘦𝘴 𝘰𝘧 𝘮𝘰𝘳𝘦 𝘵𝘩𝘢𝘯 2 𝘭𝘣 𝘱𝘦𝘳 𝘥𝘢𝘺 𝘶𝘴𝘶𝘢𝘭𝘭𝘺 𝘪𝘯𝘥𝘪𝘤𝘢𝘵𝘦 𝘧𝘭𝘶𝘪𝘥 𝘳𝘢𝘵𝘩𝘦𝘳 𝘵𝘩𝘢𝘯 𝘯𝘶𝘵𝘳𝘪𝘵𝘪𝘰𝘯𝘢𝘭 𝘧𝘢𝘤𝘵𝘰𝘳𝘴; 1 𝘓 𝘰𝘧 𝘧𝘭𝘶𝘪𝘥 𝘦𝘲𝘶𝘢𝘭𝘴 1 𝘬𝘨, 𝘰𝘳 𝘢𝘱𝘱𝘳𝘰𝘹𝘪𝘮𝘢𝘵𝘦𝘭𝘺 2.2 𝘭𝘣 (334). -1 𝘭𝘣 = ~450𝘮𝘓 𝘧𝘭𝘶𝘪𝘥; 𝘔𝘶𝘭𝘵𝘪𝘱𝘭𝘺 𝘥𝘪𝘧𝘧𝘦𝘳𝘦𝘯𝘤𝘦 𝘪𝘯 𝘸𝘦𝘪𝘨𝘩𝘵 𝘣𝘺 450𝘮𝘓

8. As serum osmolality rises, intravascular fluid equilibrium will be maintained by the release of what substance? · Ketones · Glucagon · Antidiuretic hormone · Potassium

· Antidiuretic hormone -𝘞𝘩𝘦𝘯 𝘵𝘩𝘦 𝘴𝘦𝘳𝘶𝘮 𝘰𝘴𝘮𝘰𝘭𝘢𝘭𝘪𝘵𝘺 𝘭𝘦𝘷𝘦𝘭 𝘪𝘯𝘤𝘳𝘦𝘢𝘴𝘦𝘴, 𝘢𝘯𝘵𝘪𝘥𝘪𝘶𝘳𝘦𝘵𝘪𝘤 𝘩𝘰𝘳𝘮𝘰𝘯𝘦 (𝘈𝘋𝘏) 𝘪𝘴 𝘳𝘦𝘭𝘦𝘢𝘴𝘦𝘥 𝘧𝘳𝘰𝘮 𝘵𝘩𝘦 𝘱𝘰𝘴𝘵𝘦𝘳𝘪𝘰𝘳 𝘱𝘪𝘵𝘶𝘪𝘵𝘢𝘳𝘺 𝘨𝘭𝘢𝘯𝘥 𝘢𝘯𝘥 𝘴𝘵𝘪𝘮𝘶𝘭𝘢𝘵𝘦𝘴 𝘪𝘯𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘸𝘢𝘵𝘦𝘳 𝘳𝘦𝘴𝘰𝘳𝘱𝘵𝘪𝘰𝘯 𝘪𝘯 𝘵𝘩𝘦 𝘬𝘪𝘥𝘯𝘦𝘺 𝘵𝘶𝘣𝘶𝘭𝘦𝘴 (336). -𝘛𝘩𝘦 𝘯𝘰𝘳𝘮𝘢𝘭 𝘴𝘦𝘳𝘶𝘮 𝘰𝘴𝘮𝘰𝘭𝘢𝘭𝘪𝘵𝘺 𝘪𝘴 275 𝘵𝘰 295 𝘮𝘖𝘴𝘮/𝘓 (336).

20. A patient is admitted with acute kidney injury. The nurse would expect to see elevated values in which laboratory results? (Select all that apply). · Blood urea nitrogen (BUN) · Creatinine · Glucose · Hemoglobin and hematocrit · Protein

· Blood urea nitrogen (BUN) · Creatinine -𝘞𝘪𝘵𝘩 𝘬𝘪𝘥𝘯𝘦𝘺 𝘥𝘺𝘴𝘧𝘶𝘯𝘤𝘵𝘪𝘰𝘯, 𝘵𝘩𝘦 𝘉𝘜𝘕 𝘪𝘴 ↑ 𝘣𝘤 𝘰𝘧 𝘢 ↓ 𝘪𝘯 𝘵𝘩𝘦 𝘎𝘍𝘙 𝘢𝘯𝘥 𝘳𝘦𝘴𝘶𝘭𝘵𝘪𝘯𝘨 ↓ 𝘪𝘯 𝘶𝘳𝘦𝘢 𝘦𝘹𝘤𝘳𝘦𝘵𝘪𝘰𝘯. 𝘌𝘭𝘦𝘷𝘢𝘵𝘪𝘰𝘯𝘴 𝘪𝘯 𝘵𝘩𝘦 𝘉𝘜𝘕 𝘤𝘢𝘯 𝘣𝘦 𝘤𝘰𝘳𝘳𝘦𝘭𝘢𝘵𝘦𝘥 𝘸𝘪𝘵𝘩 𝘵𝘩𝘦 𝘤𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘮𝘢𝘯𝘪𝘧𝘦𝘴𝘵𝘢𝘵𝘪𝘰𝘯𝘴 𝘰𝘧 𝘶𝘳𝘦𝘮𝘪𝘢; 𝘢𝘴 𝘵𝘩𝘦 𝘉𝘜𝘕 𝘳𝘪𝘴𝘦𝘴, 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘰𝘧 𝘶𝘳𝘦𝘮𝘪𝘢 𝘣𝘦𝘤𝘰𝘮𝘦 𝘮𝘰𝘳𝘦 𝘱𝘳𝘰𝘯𝘰𝘶𝘯𝘤𝘦𝘥. -𝘊𝘳𝘦𝘢𝘵𝘪𝘯𝘪𝘯𝘦 𝘭𝘦𝘷𝘦𝘭𝘴 𝘢𝘳𝘦 𝘧𝘢𝘪𝘳𝘭𝘺 𝘤𝘰𝘯𝘴𝘵𝘢𝘯𝘵 𝘢𝘯𝘥 𝘢𝘳𝘦 𝘢𝘧𝘧𝘦𝘤𝘵𝘦𝘥 𝘣𝘺 𝘧𝘦𝘸𝘦𝘳 𝘧𝘢𝘤𝘵𝘰𝘳𝘴 𝘵𝘩𝘢𝘯 𝘉𝘜𝘕. 𝘈𝘴 𝘢 𝘳𝘦𝘴𝘶𝘭𝘵, 𝘵𝘩𝘦 𝘴𝘦𝘳𝘶𝘮 𝘤𝘳𝘦𝘢𝘵𝘪𝘯𝘪𝘯𝘦 𝘭𝘦𝘷𝘦𝘭 𝘪𝘴 𝘢 𝘮𝘰𝘳𝘦 𝘴𝘦𝘯𝘴𝘪𝘵𝘪𝘷𝘦 𝘢𝘯𝘥 𝘴𝘱𝘦𝘤𝘪𝘧𝘪𝘤 𝘪𝘯𝘥𝘪𝘤𝘢𝘵𝘰𝘳 𝘰𝘧 𝘬𝘪𝘥𝘯𝘦𝘺 𝘧𝘶𝘯𝘤𝘵𝘪𝘰𝘯 𝘵𝘩𝘢𝘯 𝘉𝘜𝘕. 𝘊𝘳𝘦𝘢𝘵𝘪𝘯𝘪𝘯𝘦 𝘦𝘹𝘤𝘦𝘴𝘴 𝘰𝘤𝘤𝘶𝘳𝘴 𝘮𝘰𝘴𝘵 𝘰𝘧𝘵𝘦𝘯 𝘪𝘯 𝘱𝘦𝘳𝘴𝘰𝘯𝘴 𝘸𝘪𝘵𝘩 𝘢𝘤𝘶𝘵𝘦 𝘬𝘪𝘥𝘯𝘦𝘺 𝘪𝘯𝘫𝘶𝘳𝘺 𝘳𝘦𝘴𝘶𝘭𝘵𝘪𝘯𝘨 𝘧𝘳𝘰𝘮 𝘪𝘮𝘱𝘢𝘪𝘳𝘦𝘥 𝘦𝘹𝘤𝘳𝘦𝘵𝘪𝘰𝘯. -𝘋𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘩𝘦𝘮𝘢𝘵𝘰𝘤𝘳𝘪𝘵 𝘷𝘢𝘭𝘶𝘦 𝘤𝘢𝘯 𝘪𝘯𝘥𝘪𝘤𝘢𝘵𝘦 𝘧𝘭𝘶𝘪𝘥 𝘷𝘰𝘭𝘶𝘮𝘦 𝘦𝘹𝘤𝘦𝘴𝘴 𝘣𝘦𝘤𝘢𝘶𝘴𝘦 𝘰𝘧 𝘵𝘩𝘦 𝘥𝘪𝘭𝘶𝘵𝘪𝘰𝘯𝘢𝘭 𝘦𝘧𝘧𝘦𝘤𝘵 𝘰𝘧 𝘵𝘩𝘦 𝘦𝘹𝘵𝘳𝘢 𝘧𝘭𝘶𝘪𝘥 𝘭𝘰𝘢𝘥. 𝘋𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘴 𝘢𝘭𝘴𝘰 𝘤𝘢𝘯 𝘳𝘦𝘴𝘶𝘭𝘵 𝘧𝘳𝘰𝘮 𝘢𝘯𝘦𝘮𝘪𝘢𝘴, 𝘣𝘭𝘰𝘰𝘥 𝘭𝘰𝘴𝘴, 𝘭𝘪𝘷𝘦𝘳 𝘥𝘢𝘮𝘢𝘨𝘦, 𝘰𝘳 𝘩𝘦𝘮𝘰𝘭𝘺𝘵𝘪𝘤 𝘳𝘦𝘢𝘤𝘵𝘪𝘰𝘯𝘴. 𝘐𝘯 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭𝘴 𝘸𝘪𝘵𝘩 𝘢𝘤𝘶𝘵𝘦 𝘬𝘪𝘥𝘯𝘦𝘺 𝘪𝘯𝘫𝘶𝘳𝘺, 𝘢𝘯𝘦𝘮𝘪𝘢 𝘮𝘢𝘺 𝘰𝘤𝘤𝘶𝘳 𝘦𝘢𝘳𝘭𝘺 𝘪𝘯 𝘵𝘩𝘦 𝘥𝘪𝘴𝘦𝘢𝘴𝘦.

18. What causes the presence of myoglobin in urine? (Select all that apply.) · Infection · Crush injury · Acidosis · Rhabdomyolysis · Volume deficit

· Crush injury · Rhabdomyolysis 𝘜𝘳𝘪𝘯𝘢𝘭𝘺𝘴𝘪𝘴 𝘙𝘦𝘴𝘶𝘭𝘵𝘴, 𝘛𝘢𝘣𝘭𝘦 18.2 (336).

6. A patient has been admitted with acute kidney injury. The nurse knows the most important consideration for evaluating the patient's fluid status is what parameter? Select two. · Daily weights · Urine and serum osmolality · Intake and output · Hemoglobin and hematocrit levels

· Daily weights · Intake and output

5. In a patient with a distended abdomen differentiating ascites from solid bowel contents is accomplished by performing what assessment? · Auscultation of bowel sounds · Palpation of the liver margin · Measuring abdominal girth · Eliciting a fluid wave

· Eliciting a fluid wave 𝘋𝘪𝘧𝘧𝘦𝘳𝘦𝘯𝘵𝘪𝘢𝘵𝘪𝘯𝘨 𝘢𝘴𝘤𝘪𝘵𝘦𝘴 𝘧𝘳𝘰𝘮 𝘥𝘪𝘴𝘵𝘰𝘳𝘵𝘪𝘰𝘯 𝘤𝘢𝘶𝘴𝘦𝘥 𝘣𝘺 𝘴𝘰𝘭𝘪𝘥 𝘣𝘰𝘸𝘦𝘭 𝘤𝘰𝘯𝘵𝘦𝘯𝘵𝘴 𝘪𝘴 𝘢𝘤𝘤𝘰𝘮𝘱𝘭𝘪𝘴𝘩𝘦𝘥 𝘣𝘺 𝘱𝘳𝘰𝘥𝘶𝘤𝘪𝘯𝘨 𝘢 𝘧𝘭𝘶𝘪𝘥 𝘸𝘢𝘷𝘦 (334).

11. A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. Which diagnostic tests would provide the best information about the internal kidney structures, such as the parenchyma, calyces, pelvis, ureters, and bladder? · Kidney-ureter-bladder (KUB) · Intravenous pyelography (IVP) · Renal ultrasonography (USG) · Renal angiography

· Intravenous pyelography (IVP) -𝘐𝘯𝘵𝘳𝘢𝘷𝘦𝘯𝘰𝘶𝘴 𝘪𝘯𝘫𝘦𝘤𝘵𝘪𝘰𝘯 𝘰𝘧 𝘤𝘰𝘯𝘵𝘳𝘢𝘴𝘵 𝘢𝘨𝘦𝘯𝘵 𝘸𝘪𝘵𝘩 𝘳𝘢𝘥𝘪𝘰𝘨𝘳𝘢𝘱𝘩𝘺; 𝘢𝘭𝘭𝘰𝘸𝘴 𝘷𝘪𝘴𝘶𝘢𝘭𝘪𝘻𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘪𝘯𝘵𝘦𝘳𝘯𝘢𝘭 𝘬𝘪𝘥𝘯𝘦𝘺 𝘵𝘪𝘴𝘴𝘶𝘦𝘴 -𝘒𝘪𝘥𝘯𝘦𝘺 𝘐𝘮𝘢𝘨𝘪𝘯𝘨 𝘛𝘦𝘴𝘵𝘴, 𝘛𝘢𝘣𝘭𝘦 18.3 (336).

17. A patient has been on complete bed rest for 3 days. The practitioner has left orders to get the patient out of bed for meals. The patient complains of feeling dizzy and faint while sitting at the bedside. The nurse suspects that the patient is experiencing what problem? · Orthostatic hypertension · Orthostatic hypotension · Hypervolemia · Electrolyte imbalance

· Orthostatic hypotension

3. A patient was admitted with acute heart failure who has been receiving diuretic therapy. The nurse suspects the patient is hypovolemic. What auscultatory parameter would confirm the nurse's suspicion? · Hypertension · Third or fourth heart sound · Orthostatic hypotension · Vascular bruit

· Orthostatic hypotension

2. Patient has been admitted who is severely malnourished. The patient's serum albumin is very low. Which finding would the nurse expect to see in this patient? · Peripheral edema · Extra heart sounds · Hypertension · Hyponatremia

· Peripheral edema 𝘈 𝘭𝘰𝘴𝘴 𝘰𝘧 𝘢𝘭𝘣𝘶𝘮𝘪𝘯 𝘧𝘳𝘰𝘮 𝘵𝘩𝘦 𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘴𝘱𝘢𝘤𝘦 𝘤𝘢𝘯 𝘤𝘢𝘶𝘴𝘦 𝘱𝘦𝘳𝘪𝘱𝘩𝘦𝘳𝘢𝘭 𝘦𝘥𝘦𝘮𝘢 𝘥𝘦𝘴𝘱𝘪𝘵𝘦 𝘩𝘺𝘱𝘰𝘷𝘰𝘭𝘦𝘮𝘪𝘢 𝘰𝘳 𝘯𝘰𝘳𝘮𝘢𝘭 𝘧𝘭𝘶𝘪𝘥 𝘴𝘵𝘢𝘵𝘦𝘴 (331).

1. A patient was admitted with multiple trauma who has been volume resuscitated. The nurse suspects the patient is fluid overloaded. Which assessment findings would confirm the nurse's suspicion? · Venous filling of the hand veins greater than 5 seconds · Distended neck veins in the supine position · Presence of orthostatic hypotension · Presence of a third heart sound

· Presence of a third heart sound 𝘍𝘭𝘶𝘪𝘥 𝘰𝘷𝘦𝘳𝘭𝘰𝘢𝘥 𝘪𝘴 𝘰𝘧𝘵𝘦𝘯 𝘢𝘤𝘤𝘰𝘮𝘱𝘢𝘯𝘪𝘦𝘥 𝘣𝘺 𝘢 𝘵𝘩𝘪𝘳𝘥 𝘰𝘳 𝘧𝘰𝘶𝘳𝘵𝘩 𝘩𝘦𝘢𝘳𝘵 𝘴𝘰𝘶𝘯𝘥, 𝘸𝘩𝘪𝘤𝘩 𝘪𝘴 𝘣𝘦𝘴𝘵 𝘩𝘦𝘢𝘳𝘥 𝘸𝘪𝘵𝘩 𝘵𝘩𝘦 𝘣𝘦𝘭𝘭 𝘰𝘧 𝘵𝘩𝘦 𝘴𝘵𝘦𝘵𝘩𝘰𝘴𝘤𝘰𝘱𝘦 (333).

4. Percussion of kidneys is usually done to assess what parameter? · Size and shape of the kidneys · Presence of pain in the renal area · Presence of a fluid wave · Patient's overall fluid status

· Presence of pain in the renal area 𝘗𝘦𝘳𝘤𝘶𝘴𝘴𝘪𝘰𝘯 𝘪𝘴 𝘱𝘦𝘳𝘧𝘰𝘳𝘮𝘦𝘥 𝘵𝘰 𝘥𝘦𝘵𝘦𝘤𝘵 𝘱𝘢𝘪𝘯 𝘪𝘯 𝘵𝘩𝘦 𝘢𝘳𝘦𝘢 𝘰𝘧 𝘢 𝘬𝘪𝘥𝘯𝘦𝘺 𝘰𝘳 𝘵𝘰 𝘥𝘦𝘵𝘦𝘳𝘮𝘪𝘯𝘦 𝘦𝘹𝘤𝘦𝘴𝘴 𝘢𝘤𝘤𝘶𝘮𝘶𝘭𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘢𝘪𝘳, 𝘧𝘭𝘶𝘪𝘥, 𝘰𝘳 𝘴𝘰𝘭𝘪𝘥𝘴 𝘢𝘳𝘰𝘶𝘯𝘥 𝘵𝘩𝘦 𝘬𝘪𝘥𝘯𝘦𝘺𝘴 (333).

7. A patient has been admitted in acute heart failure. Which parameter would indicate to the nurse that the patient is fluid overloaded? · Central venous pressure of 4 mm Hg · Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg · Cardiac index of 2.5 L/min/m2 · Mean arterial pressure of 40 mm Hg

· Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg 𝘛𝘩𝘦 𝘯𝘰𝘳𝘮𝘢𝘭 𝘗𝘈𝘖𝘗 𝘳𝘢𝘯𝘨𝘦 𝘪𝘴 𝘧𝘳𝘰𝘮 5 𝘵𝘰 12 𝘮𝘮 𝘏𝘨 (108).

19. A patient has been admitted in acute kidney failure with a 10-lb weight gain over 5 days. Which findings may be present in the patient? (Select all that apply.) · S3 or S4 · Distended neck veins · Crackles · Tachycardia with hypotension · Edema that disappears with elevation of extremity

· S3 or S4 · Distended neck veins · Crackles 𝘛𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵 𝘪𝘴 𝘪𝘯 𝘧𝘭𝘶𝘪𝘥 𝘰𝘷𝘦𝘳𝘭𝘰𝘢𝘥. 𝘈𝘯 𝘚3 𝘰𝘳 𝘚4, 𝘥𝘪𝘴𝘵𝘦𝘯𝘥𝘦𝘥 𝘯𝘦𝘤𝘬 𝘷𝘦𝘪𝘯𝘴, 𝘢𝘯𝘥 𝘤𝘳𝘢𝘤𝘬𝘭𝘦𝘴 𝘮𝘢𝘺 𝘣𝘦 𝘱𝘳𝘦𝘴𝘦𝘯𝘵 𝘪𝘯 𝘵𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵. 𝘛𝘢𝘤𝘩𝘺𝘤𝘢𝘳𝘥𝘪𝘢 𝘸𝘪𝘵𝘩 𝘩𝘺𝘱𝘰𝘵𝘦𝘯𝘴𝘪𝘰𝘯 𝘪𝘴 𝘪𝘯𝘥𝘪𝘤𝘢𝘵𝘪𝘷𝘦 𝘰𝘧 𝘩𝘺𝘱𝘰𝘷𝘰𝘭𝘦𝘮𝘪𝘢. 𝘋𝘦𝘱𝘦𝘯𝘥𝘦𝘯𝘵 𝘦𝘥𝘦𝘮𝘢 𝘵𝘩𝘢𝘵 𝘥𝘪𝘴𝘢𝘱𝘱𝘦𝘢𝘳𝘴 𝘸𝘪𝘵𝘩 𝘦𝘭𝘦𝘷𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘵𝘩𝘦 𝘦𝘹𝘵𝘳𝘦𝘮𝘪𝘵𝘺 𝘪𝘴 𝘪𝘯𝘥𝘪𝘤𝘢𝘵𝘪𝘷𝘦 𝘰𝘧 𝘱𝘰𝘰𝘳 𝘤𝘪𝘳𝘤𝘶𝘭𝘢𝘵𝘪𝘰𝘯.

13. When calculating the anion gap, what is the predominant cation? · Sodium · Potassium · Chloride · Bicarbonate

· Sodium Na - (Cl + HCO3) = anion gap 𝘐𝘯 𝘱𝘭𝘢𝘴𝘮𝘢, 𝘴𝘰𝘥𝘪𝘶𝘮 𝘪𝘴 𝘵𝘩𝘦 𝘱𝘳𝘦𝘥𝘰𝘮𝘪𝘯𝘢𝘯𝘵 𝘤𝘢𝘵𝘪𝘰𝘯, 𝘢𝘯𝘥 𝘤𝘩𝘭𝘰𝘳𝘪𝘥𝘦 𝘪𝘴 𝘵𝘩𝘦 𝘱𝘳𝘦𝘥𝘰𝘮𝘪𝘯𝘢𝘯𝘵 𝘢𝘯𝘪𝘰𝘯 (336).

9. A patient was admitted with acute kidney injury. Which urinalysis value reflects a decreased ability of the kidneys to concentrate urine? · pH of 5.0 · Specific gravity of 1.000 · No casts · Urine sodium of 140 mEq/24 hr

· Specific gravity of 1.000 -𝘕𝘰𝘳𝘮𝘢𝘭 𝘜𝘳𝘪𝘯𝘦 𝘴𝘱𝘦𝘤𝘪𝘧𝘪𝘤 𝘨𝘳𝘢𝘷𝘪𝘵𝘺 = 1.003 𝘵𝘰 1.030 (336). -𝘜𝘳𝘪𝘯𝘦 𝘱𝘏 = 4.5 𝘵𝘰 8

16. The patient complains of a metallic taste and loss of appetite. The nurse is concerned that the patient has developed what problem? · Glycosuria · Proteinuria · Myoglobin · Uremia

· Uremia 𝘈 𝘩𝘪𝘴𝘵𝘰𝘳𝘺 𝘰𝘧 𝘳𝘦𝘤𝘦𝘯𝘵 𝘰𝘯𝘴𝘦𝘵 𝘰𝘧 𝘯𝘢𝘶𝘴𝘦𝘢 𝘢𝘯𝘥 𝘷𝘰𝘮𝘪𝘵𝘪𝘯𝘨 𝘰𝘳 𝘢𝘱𝘱𝘦𝘵𝘪𝘵𝘦 𝘭𝘰𝘴𝘴 𝘤𝘢𝘶𝘴𝘦𝘥 𝘣𝘺 𝘵𝘢𝘴𝘵𝘦 𝘤𝘩𝘢𝘯𝘨𝘦𝘴 (𝙪𝙧𝙚𝙢𝙞𝙖 𝙤𝙛𝙩𝙚𝙣 𝙘𝙖𝙪𝙨𝙚𝙨 𝙖 𝙢𝙚𝙩𝙖𝙡𝙡𝙞𝙘 𝙩𝙖𝙨𝙩𝙚) 𝘮𝘢𝘺 𝘱𝘳𝘰𝘷𝘪𝘥𝘦 𝘤𝘭𝘶𝘦𝘴 𝘵𝘰 𝘵𝘩𝘦 𝘳𝘢𝘱𝘪𝘥 𝘰𝘯𝘴𝘦𝘵 𝘰𝘧 𝘬𝘪𝘥𝘯𝘦𝘺 𝘱𝘳𝘰𝘣𝘭𝘦𝘮𝘴 (331).

14. A patient was admitted with acute heart failure a few days ago. Today the patient's urine has a specific gravity of 1.040. What could be the potential cause for this value? · Volume overload · Volume deficit · Acidosis · Urine ketones

· Volume deficit

10. A patient is admitted in acute kidney injury. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. The nurse suspects the main cause of ascites is what condition? · Hypovolemia · Dehydration · Volume overload · Liver damage

· Volume overload -𝘌𝘥𝘦𝘮𝘢 𝘪𝘴 𝘵𝘩𝘦 𝘱𝘳𝘦𝘴𝘦𝘯𝘤𝘦 𝘰𝘧 𝘦𝘹𝘤𝘦𝘴𝘴 𝘧𝘭𝘶𝘪𝘥 𝘪𝘯 𝘵𝘩𝘦 𝘪𝘯𝘵𝘦𝘳𝘴𝘵𝘪𝘵𝘪𝘢𝘭 𝘴𝘱𝘢𝘤𝘦, 𝘢𝘯𝘥 𝘪𝘵 𝘤𝘢𝘯 𝘣𝘦 𝘢 𝘴𝘪𝘨𝘯 𝘰𝘧 𝘷𝘰𝘭𝘶𝘮𝘦 𝘰𝘷𝘦𝘳𝘭𝘰𝘢𝘥 (332). -𝘐𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭𝘴 𝘸𝘪𝘵𝘩 𝘬𝘪𝘥𝘯𝘦𝘺 𝘧𝘢𝘪𝘭𝘶𝘳𝘦 𝘮𝘢𝘺 𝘩𝘢𝘷𝘦 𝘢𝘴𝘤𝘪𝘵𝘦𝘴 𝘤𝘢𝘶𝘴𝘦𝘥 𝘣𝘺 𝘷𝘰𝘭𝘶𝘮𝘦 𝘰𝘷𝘦𝘳𝘭𝘰𝘢𝘥, 𝘸𝘩𝘪𝘤𝘩 𝘧𝘰𝘳𝘤𝘦𝘴 𝘧𝘭𝘶𝘪𝘥 𝘪𝘯𝘵𝘰 𝘵𝘩𝘦 𝘢𝘣𝘥𝘰𝘮𝘦𝘯 𝘢𝘴 𝘢 𝘳𝘦𝘴𝘶𝘭𝘵 𝘰𝘧 𝘪𝘯𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘤𝘢𝘱𝘪𝘭𝘭𝘢𝘳𝘺 𝘩𝘺𝘥𝘳𝘰𝘴𝘵𝘢𝘵𝘪𝘤 𝘱𝘳𝘦𝘴𝘴𝘶𝘳𝘦𝘴 (334). -𝘞𝘩𝘦𝘯 𝘪𝘯𝘵𝘢𝘬𝘦 𝘦𝘹𝘤𝘦𝘦𝘥𝘴 𝘰𝘶𝘵𝘱𝘶𝘵 (𝘦.𝘨., 𝘦𝘹𝘤𝘦𝘴𝘴𝘪𝘷𝘦 𝘪𝘯𝘵𝘳𝘢𝘷𝘦𝘯𝘰𝘶𝘴 𝘧𝘭𝘶𝘪𝘥, 𝘥𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘶𝘳𝘪𝘯𝘦 𝘰𝘶𝘵𝘱𝘶𝘵), 𝘢 𝘱𝘰𝘴𝘪𝘵𝘪𝘷𝘦 𝘧𝘭𝘶𝘪𝘥 𝘣𝘢𝘭𝘢𝘯𝘤𝘦 𝘦𝘹𝘪𝘴𝘵𝘴. 𝘞𝘪𝘵𝘩 𝘪𝘮𝘱𝘢𝘪𝘳𝘦𝘥 𝘬𝘪𝘥𝘯𝘦𝘺 𝘧𝘶𝘯𝘤𝘵𝘪𝘰𝘯, 𝘵𝘩𝘦 𝘱𝘰𝘴𝘪𝘵𝘪𝘷𝘦 𝘧𝘭𝘶𝘪𝘥 𝘣𝘢𝘭𝘢𝘯𝘤𝘦 𝘳𝘦𝘴𝘶𝘭𝘵𝘴 𝘪𝘯 𝘧𝘭𝘶𝘪𝘥 𝘷𝘰𝘭𝘶𝘮𝘦 𝘰𝘷𝘦𝘳𝘭𝘰𝘢𝘥 (334).