Chapter 28: Acute Kidney & Chronic Kidney Disease

True or False: the best intervention for acute kidney injury (AKI) is prevention

True

The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN) in hospitalized patient is a. contrast media b. antibiotics c. cancer chemotherapy d. recreational drugs

a. contrast media

Which intervention has been found to retard the advancement of chronic kidney disease? a. calcium supplementation b. erythropoietin c. insulin d. ACE inhibitors

d. ACE inhibitors

Appropriate therapy for prerenal kidney injury includes a. fluid administration b. potassium supplementation c. fluid restriction d. protein restriction

a. fluid administration

What problem is a patient likely to experience in end-stage renal disease? a. hypokalemia b. polyuria and nocturia c. uremia d. hematuria

c. uremia

A primary laboratory finding in end-stage chronic renal disease is a. decreased blood urea nitrogen (BUN). b. decreased serum sodium. c. metabolic alkalosis. d. increased serum creatinine.

d increases serum creatine

A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate, because a. the basement membrane becomes increasingly permeable b. filtration exceeds secretory and re-absorptive capacity c. excessive solute and water are lost in the urine d. GFR declines

d. GFR declines

Osteoporosis commonly occurs in patients with end-stage renal disease because of a. hyperparathyroidism b. hypercalcemia c. excess active vitamin D d. phosphorous deficiency

a. hyperparathyroidism

True or False: hypotension is a both a cause of chronic kidney and result of chronic kidney disease

False

One of the most frequent causes of chronic kidney disease is a. hypertension b. glomerulonephritis c. chronic pyelonephritis d. polycystic kidney disease

a. hypertension

The risk for contrast media-induced acute tubular necrosis (ATN) is highest in a. a 70-year-old patient with heart failure. b. a 50-year-old patient post gallbladder surgery. c. a 12-year-old patient with recurrent bladder infections. d. a 30-year-old patient with appendicitis.

a. a 70-year-old patient with heart failure

The patient most at risk for postrenal acute kidney injury is a(n) a. elderly patient with hypertrophy of the prostate b. middle aged woman with bladder infection c. young child with reflux at the ureterovesical junction d. patient who has both hypertension and diabetes

a. elderly patient with hypertrophy of the prostate

The oliguric phase of acute tubular necrosis is characterized by a. fluid excess and electrolyte imbalance b. fever and diminishing cognition c. sodium retention and potassium loss in the urine d. magnesium and phosphorus loss in the urine

a. fluid ecess and electrolye imbalance

At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema, congestive signs in pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include a. initiation of dialysis b. fluid restriction c. antibiotic d. phlebotomy

a. initiation of dialysis

The most likely cause of anemia in a patient with end-stage renal disease is a. insufficient erythropoietin b. blood loss secondary to hematuria c. vitamin B12 deficiency secondary to deficient intrinsic factor. d. iron deficiency

a. insufficeinet erythropoietin

One of the most common causes of acute tubular necrosis (ATN) is a. ischemic conditions b. cytotoxic agents c. immune reaction d. prolonged postrenal kidney injury

a. ischemic conditions

The most helpful laboratory value in monitoring the progression of declining renal function is a. serum creatinine b. serum potassium c. blood urea nitrogen d. mental status changes

a. serum creatinine

Prerenal acute kidney injury may be caused by a. severe hypotension b. glomerulonephritis c. bilateral kidney stones d. acute tubular necrosis

a. severe hyptension

A patient injured severely in a motor vehicle accident is hospitalized with acute kidney injury as well as multiple broken bones and lacerations. When family members ask what is meant by the term 'prerenal,' the nurse responds a. "the doctors are not sure what caused your husband's acute kidney injury, but they are working to help him recover." b. "Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney." c. "Your husband's kidney injury is only the beginning of the problems that are expected, so they are being vigilant." d. "Acute kidney injury is a new term for what people used to call acute renal failure."

b. "Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney."

Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing a. Hydronephrosis b. acute tubular necrosis c. nephrosis d. renal inflammation

b. acute tubular necrosis

The defining characteristic of severe acute kidney injuries is a. proteinuria b. oliguria c. hematuria d. diuresis

b. oliguria

The most common cause of intrinsic kidney injury is __________ injury a. glomerular b. tubular c. interstitial d. vascular

b. tubular

A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating a. "Since he was oliguric for so long, he probably has rebound polyuria. As long as his blood pressure is stable, he is not hypovolemic, so I would not worry." b. "I am glad you noticed this change. It happened so gradually that we did not see it. We should call the doctor and get him to measure ADH." c. "His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered." d. "We had better measure his blood sugar. He may have developed diabetes, and what you see is osmotic diuresis from glucose in the urine."

c. "His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered."

Renal insufficiency offers when _________ of nephrons are not functional a. 25% b. 50% c. 75% to 90% d. more than 90%

c. 75% to 90%

Postrenal acute kidney injury may be caused by a. severe hypotension b. glomerulonephritis c. bilateral kidney stones d. acute tubular necrosis

c. bilateral kidney stones

Anemia in people who have end-stage chronic renal disease is caused by a. chronic loss of blood in the urine b. poor appetite, with lack of iron intake c. decreased secretion of erythropoietin d. increased secretion of aldosterone

c. decreased secretion os erythropoietin

Appropriate management of end-stage renal disease includes a. potassium supplementation b. high-protein diet c. erythropoietin administration d. a high-phosphate diet

c. erythropoietin adminstration

The most likely cause of acidosis in a patient with end-stage renal disease is a. insufficient filtration of bicarbonate ions at the glomerulus b. excessive production of respiratory and metabolic acids c. insufficient metabolic acid excretion resulting from nephron loss d. hypoventilation secondary to uremic central nervous system depression

c. insufficient metabolic acid excretion resulting from nephron loss

In patient with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease? a. greater than 15% b. greater than 25% nephron loss c. Greater than 50% nephron loss d. Greater than 90% nephron loss

d. Greater than 90% nephron loss

The condition associated with end-stage chronic renal disease that is the most immediately life threatening is a. azotemia b. increased creatine c. hypertension d. hyperkalemia

d. hyperkalemia

If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues, the patient will then experience a. oliguria and sodium retention. b. infections and sepsis. c. magnesium and phosphorus loss in urine. d. polyuria and sodium wasting.

d. polyuria and sodium wasting

The effect on the renal tubules during the postoliguric phase of acute tubular necrosis involves a. reconstruction of the basement membrane b. blocking the tubule lumens by dead cells c. making the glomeruli patent again d. regeneration of the renal tubular epithelium

d. regeneration of the renal tubular epithelium

The most common cause of ischemic acute tubular necrosis (ATN) in the United states is a. hypotension b. hypovolemia c. renal artery stenosis d. sepsis

d. sepsis

Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because a. excess potassium leaches calcium from bone b. erythropoietin secretion is impaired c. urea causes demineralization of bone d. they are deficient in active vitamin D

d. they are deficient in active vitamin d