Patho exam 3
A patient in the intensive care unit is being prepared to receive continuous arteriovenous hemofiltration. Which of the following sites will be used for this type of dialysis? 1. femoral vein 2. femoral artery and vein 3. brachial artery and vein 4. brachial vein
Answer: 2 Rationale: The femoral artery and vein are utilized with continuous arteriovenous hemofiltration because of the ease of access and the size of the vessel. Continuous venovenous hemofiltration and continuous venovenous hemofiltration-dialysis use a vein only. The brachial artery and vein would be considered too small to support the filtration needed for the body and would not be used.
A patient is diagnosed with a postrenal acute kidney injury. Which of the following assessment findings would support this diagnosis? 1. intake of NSAIDs for arthritis 2. vomiting with diarrhea for the last 6 days 3. heart failure diagnosis 4. large renal calculi in kidney and ureter
Answer: 4 Rationale: Large renal calculi in the kidney and ureter are considered a mechanical cause for a postrenal acute kidney injury. The intake of NSAIDs for arthritis would contribute to an intrinsic cause for an acute kidney injury. Vomiting and diarrhea for the last 6 days and the diagnosis of heart failure are both considered prerenal causes for an acute kidney injury.
Identify which substances would indicate a problem with renal function. (Select all that apply). a. protein. b. sodium. c. creatinine. d. red blood cells. e. uric acid.
a. protein. d. red blood cells. e. uric acid.
A patient's glomerular filtration rate is assessed to be 28%. The nurse realizes that this patient's renal status would be categorized as being 1. renal insufficiency. 2. end-state renal disease. 3. uremia. 4. azotemia.
Answer: 1 Rational: Renal insufficiency is defined as a decline in renal function to approximately 25% of normal. The patient's glomerular filtration rate is 28% which would place the patient in the renal insufficiency category. End-state renal disease is a decline in renal function to approximately 10%. Uremia is an increase in urea and creatinine blood levels with the symptoms of fatigue, anorexia, nausea, vomiting, pruritis, and other neurological changes. Azotemia is an increase in serum urea levels that is often associated with an increase in creatinine levels.
A patient in the intensive care unit is receiving continuous venovenous hemofiltration for acute kidney injury. Which of the following is needed to successfully provide the treatment for the patient? 1. a small pump 2. successful placement of the catheter in an artery and a vein 3. infusion of a dialysate through the hemofilter 4. a fistula
Answer: 1 Rationale: Continuous venovenous hemofiltration uses a double-lumen catheter placed in a vein. This eliminates the need for an arterial catheter and the associated risks of this device. Without the arterial pressure to "drive" the system, a small pump propels the blood from one lumen of the catheter through the hemofilter and back into the vein through the second lumen. The pump controls the blood flow and therefore the fluid removal rate. The infusion of a dialysate through the hemofilter is used with continuous arteriovenous hemodilution and continuous venovenous hemodilution. A fistula is needed when the patient will be on long term hemodialysis.
A patient with acute kidney injury is demonstrating signs of gastrointestinal bleeding. The nurse realizes that the reason for the onset of this bleeding is due to 1. increased ammonia level. 2. low creatinine level. 3. low calcium level. 4. elevated potassium level
Answer: 1 Rationale: Electrolyte imbalances and increasing levels of uremic toxins are the primary contributors to gastrointestinal manifestations. As urea decomposes in the gastrointestinal tract, it releases ammonia. Ammonia in the gastrointestinal tract increases capillary fragility and gastrointestinal mucosal irritation resulting in small mucosal ulcerations and the potential for pain, decreased appetite, and gastrointestinal bleeding. Gastrointestinal bleeding in the patient with an acute kidney injury is not due to low creatinine levels, low calcium levels, or elevated potassium levels.
A patient with an acute kidney injury is experiencing fluid volume overload. When administering Furosemide therapy to this patient, the continuous infusion should be set to administer which of the following to the patient? 1. 4 mg/minute 2. 20 mg/minute 3. according to a calculation based upon the patient's weight 4. according to a calculation based upon the patient's potassium and sodium levels
Answer: 1 Rationale: Furosemide may be given in large doses intravenously or by continuous intravenous drip. Intravenous push should not be given faster than 20 mg/minute and continuous infusions should not exceed 4 mg/minute. The nurse should set the continuous infusion to provide 4 mg of the medication per minute to the patient. Furosemide dosage is not calculated according to the patient's weight or potassium and sodium levels.
A patient, with chronic renal failure and a blood pressure of 158/98 mm Hg, refuses to take medication for the blood pressure. If left untreated, the nurse realizes that which of the following can occur in the patient? 1. heart failure 2. pericarditis 3. friction rub 4. pneumonia
Answer: 1 Rationale: Hypertension, commonly seen in chronic renal failure, can progress to heart failure if left untreated. Pericarditis, associated with uremic toxins or a result of the dialysis treatment causes chest pain, a friction rub, and possible cardiac tamponade. Pneumonia is not a potential problem because of untreated hypertension.
A patient with an acute kidney injury is identified as being at risk for infection. Which of the following interventions would be appropriate for this patient? 1. frequent hand hygiene 2. minimal manipulation of venous access devices 3. turn and reposition when necessary 4. limit the use of antibiotic therapy
Answer: 1 Rationale: Nursing interventions for the patient with acute kidney injury at risk for infection include frequent hand hygiene, vascular access care, minimize pneumonia, and prevent the onset of skin wounds. The intervention most appropriate for this patient would be frequent hand hygiene. The venous access devices should be routinely assessed, cleaned, dressed, and changed. The patient should be turned and repositioned every 2 hours to prevent the pooling of secretions in the lungs and reduce the likelihood of pressure ulcer development. Antibiotic therapy is indicated in the patient with an acute kidney injury however the dosage will need adjustment according to the patient's renal clearance rate.
A patient, weighing 90 kg, had a urine output of 25 cc over the last 12 hours. The nurse would categorize this patient's acute renal functioning as being which of the following according to the RIFLE criteria? 1. risk 2. failure 3. injury 4. loss
Answer: 2 Rationale: According to the RIFLE criteria, failure is a urine output of less than 0.3 ml per kg of body weight or anuria for 12 hours. The patient's urine output over the last 12 hours has been 25 cc which would be comparable to the failure category within the RIFLE criteria. Risk would be a urine output of 45 cc over 6 hours. Injury would be 45 cc over 12 hours. Loss would be a complete loss of renal function for at least 4 weeks.
A patient's serum creatinine level is increasing but the urine creatinine clearance is decreasing. These assessment findings would indicate which of the following to the nurse? 1. malnutrition 2. decreased glomerular functioning 3. onset of heart failure 4. associated hypokalemia
Answer: 2 Rationale: Creatinine is the end-product of muscle metabolism and is released into the blood at a constant rate. Creatinine is larger in size compared to urea and is not reabsorbed back into the blood, but is eliminated at a rate related to the level of renal function. For this reason, it is a more reliable measure of the state of renal health. A decrease in the urinary creatinine clearance rate indicates a decrease in glomerular function. A rise in serum creatinine level also indicates a decrease in glomerular functioning. These two laboratory values are not indicated to determine malnutrition, the onset of heart failure, or associated hypokalemia.
The nurse is providing care to a patient receiving intermittent hemodialysis. Which of the following will the nurse assess in this patient? 1. hypotension 2. stable blood pressure and heart rate 3. slow removal of waste products 4. gradual reduction in elevated electrolyte levels
Answer: 2 Rationale: Even though intermittent hemodialysis provides more efficient and effective clearance of excess fluids and solutes, it is destabilizing to the hemodynamic and electrolyte status of the patient. The patient receiving intermittent hemodialysis will need to have a stable blood pressure and heart rate. The patient will not demonstrate hypotension. Intermittent hemodialysis is a rapid way to remove waste products and unnecessary high levels of electrolytes. Continuous renal replacement therapy is a method of slowly removing waste products with a gradual reduction in elevated electrolyte levels.
A patient, diagnosed with acute kidney injury, is on a fluid restriction. Which of the following nursing interventions would be appropriate for this patient? 1. allow the patient to decide when the fluid will be ingested 2. frequent oral care 3. provide all fluid in the form of ice chips 4. provide fluids when the patient complains of thirst
Answer: 2 Rationale: The nurse will need to decide about how to divide the available free-water over a 24-hour period for the patient on a fluid restriction. The nurse must consider the timing of medication administration and meals in order to ensure there is adequate fluid to perform necessary treatments. Since uremic patients may experience extreme thirst, oral fluids in small quantities often increase patient comfort. Oral care is an extremely important intervention to minimize oral mucosal damage and to increase patient comfort. Using small amounts of ice chips or frozen popsicles can provide comfort with less volume. The nurse should not let the patient decide when the fluid will be ingested since there might not be available fluid for medications and treatments. All fluid should not be provided in the form of ice chips. The patient could constantly complain of thirst which would negatively impact the patient's permitted fluid volume.
A patient with reduced glomerular filtration has a blood pressure of 168/100 mm Hg. The nurse realizes that which of the following is occurring with this patient? 1. sluggish response by the renin-angiotensin system 2. rebound hypertension due to fluid volume deficit 3. increased renin production causing the retention of water and electrolytes 4. kidneys hyper-excreting hydrogen ions
Answer: 3 Rationale: Hypertension is a common manifestation of renal failure. It is caused by systemic and central fluid volume excess and increased renin production. In the presence of renal ischemia, the renin-angiotensin system is triggered and not sluggish. The patient has fluid volume excess and not deficit. The kidneys are not able to excrete hydrogen ions or hyper-excreting hydrogen ions
A patient with acute kidney injury is receiving treatment for fluid volume overload. Which of the following would indicate to the nurse that the treatment is successful? 1. normal serum protein level 2. soft formed stools 3. improved lung sounds 4. normal cardiac rhythm
Answer: 3 Rationale: In fluid volume overload, the patient will demonstrate signs of pulmonary edema, peripheral edema, and increased weight. Evidence of successful treatment would be improved lung sounds, reduction in peripheral edema, and stabilization of weight towards normal. A normal serum protein level would be outcome criteria for the nursing diagnosis of altered nutrition. Soft formed stools would also be outcome criteria for the nursing diagnosis of altered nutrition. A normal cardiac rhythm would be outcome criteria for the nursing diagnoses related to electrolyte imbalances, metabolic acidosis, and cardiac dysfunction.
An elderly patient with a glomerular filtration rate is scheduled for a CT scan with contrast. Which of the following can be provided to the patient to prevent any further renal damage? 1. vitamin B 12 2. vitamin D 3. N-acetylcystine 4. intravenous infusion of 5% dextrose
Answer: 3 Rationale: Since the use of contrast dyes can be nephrotoxic, steps must be taken to minimize nephrotoxicity. The patient should be adequately hydrated with sodium chloride. N-acetylcystine may be given orally or intravenously before contrast administration. N-acetylcystine acts as a free radical scavenger, counteracts vasoconstriction from contrast agents, and indirectly exhibits cyoprotective effects. The patient should be provided with N-acetylcystine prior to the CT scan with contrast. Vitamin B 12, vitamin D, and a dextrose 5% solution do not help reduce the nephrotoxic effects of contrast dyes.
A patient with chronic renal failure is diagnosed with anemia. The nurse realizes that which of the following might be prescribed to help this patient? 1. routine whole blood transfusions 2. protein restriction 3. recombinant erythropoietin supplementation 4. vitamin B 12 injections
Answer: 3 Rationale: The anemia of chronic renal failure is treated with recombinant human erythropoietin and iron supplementation. The patient will not need routine whole blood transfusions. Protein restriction will not help treat the anemia. Vitamin B 12 injections would not help treat this type of anemia.
A patient with acute kidney injury has a hemoglobin level of 9.0 mg/dL. Which of the following best explains why this laboratory value is decreased in the patient? 1. undiagnosed gastrointestinal bleeding 2. fluid volume overload causing hemodilution 3. decreased erythropoietin production by the kidneys 4. reduced capillary permeability in the lungs
Answer: 3 Rationale: The kidneys produce erythropoietin in response to decreased oxygen delivery to the kidneys. Erythropoietin is necessary for red blood cell production and also plays a role in maintaining healthy endothelium, promotes angiogenesis and anti-apoptosis. When kidney function deteriorates, red blood cell production is compromised and the life span of the existing red blood cells may decrease. The patient may or may not have undiagnosed gastrointestinal bleeding. The patient's fluid volume is not causing hemodilution. Reduced capillary permeability in the lungs might lead to hypoxemia.
The nurse is assessing the neurological status of a patient with chronic renal failure. Which of the following is the nurse most likely to assess in this patient? 1. weak hand grasps 2. expressive aphasia 3. flaccid paralysis 4. numbness and pain of the lower extremities
Answer: 4 Rationale: Neurological symptoms are non-specific and progressive in the patient with CRF. These symptoms include: sleep disorders, memory loss, impaired judgment, muscle cramps, and twitching. These may progress to asterixis, seizures, and coma. Peripheral neuropathy is also a component of chronic renal failure and is evidenced by numbness, tingling, or pain, especially in the lower extremities. Weak hand grasps, expressive aphasia, and flaccid paralysis are not neurological symptoms commonly seen in the patient with chronic renal failure
A patient is receiving slow continuous ultrafiltration to treat an acute kidney injury. Which of the following will the nurse need to continue to assess in this patient? 1. urine output 2. appetite 3. white blood cell count 4. electrolyte levels
Answer: 4 Rationale: Slow continuous ultrafiltration is a method of continuous renal replacement that uses both arterial and venous access and, using the patient's blood pressure, circulates blood through the hemofilter. The goal of this therapy is to remove fluid only, and the patient does not receive any replacement fluid. Toxins are not removed with this treatment and urea levels and electrolytes are not corrected. The nurse will need to continue to assess this patient's electrolyte levels. The patient is experiencing acute renal failure and may or may not have a urine output. Assessment of appetite and white blood cell count also may or may not be indicated for this patient.
Answer: 1 Rationale: Hypertension, commonly seen in chronic renal failure, can progress to heart failure if left untreated. Pericarditis, associated with uremic toxins or a result of the dialysis treatment causes chest pain, a friction rub, and possible cardiac tamponade. Pneumonia is not a potential problem because of untreated hypertension.
Answer: 4 Rationale: The integumentary status assessment findings of a patient diagnosed with chronic renal failure include pale skin from anemia and yellow-brown hue associated with uremia; dry skin and mucous membranes; decreased perspiration; and pruritis with resultant severe scratching causing skin breaks. The skin of a patient in chronic renal failure will not be damp, mottled, or flushed. The skin turgor may or may not be poor.
The patient gets hemodialysis 3 days a week. He is 74 inches tall and weighs 100 kg. In planning the care for this patient, the nurse recommends: a. 2500 to 3500 kcal diet per day. b. protein intake less than 50 grams per day. c. potassium intake of 10 mEq per day. d. fluid intake of less than 500 mL per day.
a. 2500 to 3500 kcal diet per day.
The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.) a. Acidosis b. Hypokalemia c. Volume overload d. Hyperkalemia e. Uremia
a. Acidosis c. Volume overload d. Hyperkalemia e. Uremia
The nurse is caring for a patient receiving peritoneal dialysis. The patient suddenly complains of abdominal pain and chills. The patient's temperature is elevated. The nurse should: a. assess peritoneal dialysate return. b. check the patient's blood sugar. c. evaluate the patient's neurological status. d. inform the provider of probable visceral perforation.
a. assess peritoneal dialysate return.
The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should: a. assess that the blood tubing is warm to the touch. b. assess the hemofilter every 6 hours for clotting. c. cover the dialysis lines to protect them from light. d. use clean technique during vascular access dressing changes.
a. assess that the blood tubing is warm to the touch.
The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include: (Select all that apply.) a. bladder catheterization. b. increasing fluid volume intake. c. ureteral stenting. d. placement of nephrostomy tubes. e. increasing cardiac output.
a. bladder catheterization. c. ureteral stenting. d. placement of nephrostomy tubes.
The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patient's urine output has been less than 20 mL/hour for the past 2 hours. It is 0200 in the morning. The patient's blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should: a. contact the provider and expect an order for a normal saline bolus. b. wait until 0900 when the provider makes rounds to report the assessment findings. c. continue to evaluate urine output for 2 more hours. d. ignore the urine output, as this is most likely postrenal in origin.
a. contact the provider and expect an order for a normal saline bolus.
The patient is in the critical care unit and will receive dialysis this morning. The nurse will: (Select all that apply.) a. evaluate morning laboratory results and report abnormal results. b. administer the patient's antihypertensive medications. c. assess the dialysis access site and report abnormalities. d. weigh the patient to monitor fluid status. e. give all medications except for antihypertensive medications.
a. evaluate morning laboratory results and report abnormal results. c. assess the dialysis access site and report abnormalities. d. weigh the patient to monitor fluid status.
Daily weights are being recorded for the patient. His urine output has been less than his intravenous and oral intake. His weight yesterday was 97.5 kg. This morning it is 99 kg. The nurse understands that this corresponds to a(n): a. fluid retention of 1.5 liters. b. fluid loss of 1.5 liters. c. equal intake and output due to insensible losses. d. fluid loss of 0.5 liters.
a. fluid retention of 1.5 liters.
Acute kidney injury from post renal etiology is caused by: a. obstruction of the flow of urine. b. conditions that interfere with renal perfusion. c. hypovolemia or decreased cardiac output. d. conditions that act directly on functioning kidney tissue.
a. obstruction of the flow of urine.
The nurse is caring for an elderly patient who was admitted with renal insufficiency. The nurse realizes that with advance age often comes declining renal function. An expected laboratory finding for this patient may be: a. an increased glomerular filtration rate (GFR). b. a normal serum creatinine level. c. increased ability to excrete drugs. d. hypokalemia.
b. a normal serum creatinine level.
The patient has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. These levels most likely indicate: a. increased nitrogen intake. b. acute kidney injury, such as acute tubular necrosis (ATN). c. hypovolemia. d. fluid resuscitation.
b. acute kidney injury, such as acute tubular necrosis (ATN).
With sudden cessation of renal function, all body systems are affected by the inability to maintain fluid and electrolyte balance and eliminate metabolic waste. In critically ill patients, renal dysfunction: a. is a very rare problem. b. affects nearly two thirds of patients. c. has a low mortality once renal replacement therapy has been initiated. d. has little effect on morbidity, mortality, or quality of life.
b. affects nearly two thirds of patients.
The patient is admitted to the unit with the diagnosis of rhabdomyolysis. The patient is started on intravenous (IV) fluids and IV mannitol. Because mannitol is an osmotic diuretic, the nurse should: a. assess the patient's hearing. b. assess the patient's lungs. c. decrease IV fluids once the diuretic has been administered. d. give extra doses prior to giving radiological contrast agents.
b. assess the patient's lungs.
The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is: a. oliguria. b. azotemia. c. acute kidney injury. d. prerenal disease.
b. azotemia.
The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should: a. prepare to assist with a routine dialysis catheter change to replace the existing catheter. b. evaluate the patient for signs and symptoms of infection. c. teach the patient that the catheter is designed for long-term use. d. use one of the three lumens for fluid administration.
b. evaluate the patient for signs and symptoms of infection.
The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should: a. not be concerned unless urine output decreases. b. evaluate the patient's serum creatinine for up to 72 hours after the procedure. c. obtain an order for a renal ultrasound. d. evaluate the patient's post void residual volume to detect intrarenal injury.
b. evaluate the patient's serum creatinine for up to 72 hours after the procedure.
The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. His blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; he has not voided in 8 hours and his bladder is not distended. The nurse anticipates an order for "stat" administration of: a. a blood transfusion. b. fluid replacement with 0.45% saline. c. infusion of an inotropic agent. d. an antiemetic.
b. fluid replacement with 0.45% saline.
The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas is ordered and shows that the patient's pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to: a. administer morphine to slow the respiratory rate. b. prepare for intubation and mechanical ventilation. c. administer intravenous sodium bicarbonate. d. cancel tomorrow's dialysis session.
c. administer intravenous sodium bicarbonate.
The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place. In caring for this patient, the nurse should: a. apply a sterile gauze dressing to maintain sterility. b. replace the transparent dressing every 10 days to prevent manipulation. c. assess the catheter site for redness and/or swelling. d. use the catheter for drawing blood samples to reduce patient discomfort.
c. assess the catheter site for redness and/or swelling.
The patient is on intake and output (I&O) as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should: a. draw a trough level after the next dose of antibiotic. b. obtain an order to place the patient on fluid restriction. c. assess the patient's lungs. d. insert an indwelling catheter.
c. assess the patient's lungs.
The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of: a. dialyzer membrane incompatibility. b. a shift in potassium levels. c. dialysis disequilibrium syndrome. d. hypothermia.
c. dialysis disequilibrium syndrome.
The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient's urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has: a. acute kidney injury from a prerenal condition. b. acute kidney injury from postrenal obstruction. c. intrarenal disease, probably acute tubular necrosis. d. a urinary tract infection.
c. intrarenal disease, probably acute tubular necrosis.
In calculating the glomerular filtration rate (GFR) results for women, the creatinine clearance is usually: a. the same as for men. b. greater than that for men. c. multiplied by 0.85. d. multiplied by 1.15.
c. multiplied by 0.85.
The nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should: a. reassess the patient in an hour. b. raise the arm above the level of the patient's heart. c. notify the provider immediately. d. apply warm packs to the fistula site and reassess.
c. notify the provider immediately.
Continuous venovenous hemodialysis is used to: a. remove fluids and solutes through the process of convection. b. remove plasma water in cases of volume overload. c. remove plasma water and solutes by adding dialysate. d. combine ultrafiltration, convection and dialysis
c. remove plasma water and solutes by adding dialysate.
Renin plays a role in blood pressure regulation by: a. activating the renin-angiotensin-aldosterone cascade. b. suppressing angiotensin production. c. decreasing sodium reabsorption. d. inhibiting aldosterone release.
a. activating the renin-angiotensin-aldosterone cascade.
Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.) a. Hypotension b. Dysrhythmias c. Muscle cramps d. Hemolysis e. Air embolism
a. Hypotension b. Dysrhythmias
The patient's potassium level is 7.0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction? a. Kayexalate b. Kayexalate with sorbitol c. Regular insulin d. Calcium gluconate
a. Kayexalate
Noninvasive diagnostic procedures used to determine kidney function include which of the following? (Select all that apply.) a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI) d. Intravenous pyelography (IVP) e. Renal angiography
a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI)
The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for insertion of: a. a percutaneous catheter at the bedside. b. a percutaneous tunneled catheter at the bedside. c. an arteriovenous fistula. d. an arteriovenous graft.
a. a percutaneous catheter at the bedside.
Continuous venovenous hemofiltration is used to: a. remove fluids and solutes through the process of convection. b. remove plasma water in cases of volume overload. c. remove plasma water and solutes by adding dialysate. d. combine ultrafiltration, convection and dialysis.
a. remove fluids and solutes through the process of convection.
Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used to: a. remove plasma water in cases of volume overload. b. remove fluids and solutes through the process of convection. c. remove plasma water and solutes by adding dialysate. d. combine ultrafiltration, convection and dialysis.
a. remove plasma water in cases of volume overload.
The most common cause of acute kidney injury in critically ill patients is: a. sepsis. b. fluid overload. c. medications. d. hemodynamic instability.
a. sepsis.
The patient is a new postoperative patient. She weighs 75 kg. The nurse expects the minimal acceptable urine output to be: a. less than 30 mL/hour. b. 37 mL/hour. c. 80 mL/hour. d. 150 mL/hour.
b. 37 mL/hour.
The patient's serum creatinine level is 0.7 mg/dL. The expected BUN level should be: a. 1-2 mg/dL. b. 7-14 mg/dL. c. 10-20 mg/dL. d. 20-30 mg/dL.
b. 7-14 mg/dL.
A normal glomerular filtration rate is: a. less than 80 mL/min. b. 80 to 125 mL/min c. 125 to 180 mL/min d. more than 189 mL/min
b. 80 to 125 mL/min
The patient is complaining of severe flank pain when he tries to urinate. His urinalysis shows sediment and crystals along with a few bacteria. Using this information along with the clinical picture, the nurse realizes that the patient's condition is: a. prerenal. b. postrenal. c. intrarenal. d. not renal related.
b. postrenal
Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis: a. is more frequently used for acute kidney injury. b. uses the patient's own semipermeable membrane (peritoneal membrane). c. is not useful in cases of drug overdose or electrolyte imbalance. d. is not indicated in cases of water intoxication.
b. uses the patient's own semipermeable membrane (peritoneal membrane).
The patient has just returned from having an arteriovenous fistula placed. The patient asks, "When will they be able to use this and take this other catheter out?" The nurse should reply, a. "It can be used immediately so the catheter can come out anytime." b. "It will take 2 to 4 weeks to heal before it can be used." c. "The fistula will be usable in about 4 to 6 weeks." d. "The fistula was made using graft material so it depends on the manufacturer."
c. "The fistula will be usable in about 4 to 6 weeks."
Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is: a. prolonged ischemia. b. exposure to nephrotoxic substances. c. acute tubular necrosis (ATN). d. hypotension for several hours.
c. acute tubular necrosis (ATN).
Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who: a. has been on aminoglycosides for the past 6 days. b. has a history of controlled hypertension with a blood pressure of 138/88 mm Hg. c. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks. d. has a history of fluid overload as a result of heart failure.
c. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks.
The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response? a. "Unfortunately, kidney injury is not reversible; it is permanent." b. "Kidney function usually returns within 2 weeks." c. "You will know for sure if you start urinating a lot all at once." d. "recovery is possible, but it may take several months."
d. "recovery is possible, but it may take several months."
A normal urine output is considered to be: a. 80 to 125 mL/min. b. 180 L/day. c. 80 mL/min. d. 1 to 2 L/day.
d. 1 to 2 L/day.
In determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible, a. it is not possible to determine the GFR. b. the BUN may be used to determine renal function. c. an elevated BUN/creatinine ratio can be used. d. a standardized formula may be used to calculate GFR.
d. a standardized formula may be used to calculate GFR.
The patient is in progressive care unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, the nurse should: a. draw blood from the left arm. b. take blood pressures from the left arm. c. start a new intravenous line in the left lower arm. d. auscultate the left arm for a bruit and palpate for a thrill.
d. auscultate the left arm for a bruit and palpate for a thrill.
The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patient's urinalysis results. The nurse should become concerned when a. creatinine levels in the urine are similar to blood levels of creatinine. b. sodium and chloride are found in the urine. c. urine uric acid levels have the same values as serum levels. d. red blood cells and albumin are found in the urine.
d. red blood cells and albumin are found in the urine.
An advantage of peritoneal dialysis is that: a. peritoneal dialysis is time intensive. b. a decreased risk of peritonitis exists. c. biochemical disturbances are corrected rapidly. d. the danger of hemorrhage is minimal.
d. the danger of hemorrhage is minimal.
Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that: a. a hemofilter is used to facilitate ultrafiltration. b. it provides faster removal of solute and water. c. it does not allow diffusion to occur. d. the process removes solutes and water slowly.
d. the process removes solutes and water slowly.
The removal of plasma water and some low-molecular weight particles by using a pressure or osmotic gradient is known as: a. dialysis. b. diffusion. c. clearance. d. ultrafiltration.
d. ultrafiltration.
