Pathophysiology Chapter 46 AKI & ESRD
The nurse is caring for a client with acute tubular necrosis (ATN). Which problem should the nurse anticipate and monitor in the client? (Select all that apply.) A. Waste product buildup B. Fluid imbalance C. Acid-base imbalance D. Intractable pain E. Electrolyte imbalances
A, B, C, E Rationale: Acute tubular necrosis (ATN) results from damage to the renal tubular epithelium, which prevents normal concentration of urine, filtration of waste products, regulation of the acid-base balance, electrolyte hemostasis, and fluid balance. Intractable pain is not a symptom or complication of ATN.
For which finding should the nurse monitor a client in the oliguric phase of acute kidney injury (AKI)? (Select all that apply.) A. Increased creatinine B. Hypokalemia C. Weight gain D. Dehydration E. Hypernatremia
A, C, E Rationale: During the oliguric phase of AKI, fluid is retained, electrolyte levels become imbalanced, and waste products are not excreted as urine output decreases. Signs of fluid overload include weight gain and edema. Excess sodium may be noted in the urine. Hyperkalemia may also be noted. Blood urea nitrogen (BUN) and creatinine levels increase. Dehydration does not need to be monitored because fluid status will be continually assessed.
Which laboratory tests should the nurse expect to be prescribed to determine whether a client is experiencing acute kidney injury (AKI)? A. Blood urea nitrogen (BUN) and creatinine B. Sodium and potassium C. WBCs and hemoglobin D. Albumin and ammonia
A. Blood urea nitrogen (BUN) and creatinine Rationale: BUN and creatinine are indicators of kidney function and are most significant in the diagnosis of AKI. BUN level reflects the balance between production and excretion of urea from the kidneys. Creatinine is the by-product of metabolism and is excreted by the kidneys. WBC count is used to determine the presence of infection. Hemoglobin (Hgb) is used to monitor decreases in RBC function and perfusion and is often decreased in the client in chronic renal failure. Sodium and potassium are electrolytes, and their levels can be used, along with other lab tests, to determine the kidney's ability to filter the blood. Electrolytes are measured in a variety of disorders and are not specific to renal function. Albumin and ammonia levels are used to assess liver function.
A client is experiencing fatigue, frequent vomiting, and severe swelling of the feet and ankles. Which disorder should the nurse suspect is occurring with this client? A. Chronic kidney disease (CKD) B. Benign prostatic hypertrophy C. Renal cell cancer D. Prostate cancer
A. Chronic Kidney Disease (CKD) Rationale: The client's symptoms are consistent with CKD. The inability to excrete the extra fluid contributes to the swelling and fatigue. Vomiting could be caused by an acid-base imbalance. Symptoms of prostate cancer and benign prostatic hypertrophy are similar: inability to start a stream of urine, dribbling at the end of the stream, and frequency. Renal cancer usually has the symptom of painless gross hematuria.
A client is in stage 4 chronic kidney disease (CKD). Which symptom should the nurse expect to assess? A. Edema B. Hypertension C. Anorexia D. Azotemia
A. Edema Rationale: Edema results when the kidney is not producing enough urine and fluid is retained. Anorexia and azotemia are common in stage 5. Hypertension is often a cause of chronic renal failure and is evident throughout the 5 stages of CKD. Next Question
A client with chronic kidney disease (CKD) is scheduled to begin hemodialysis. Which information should the nurse include when teaching the client about the procedure? (Select all that apply.) A. Long-term hemodialysis requires the implantation of an intra-abdominal catheter. B. Short-term hemodialysis necessitates a dual-lumen vascular access or catheter. C. Long-term hemodialysis requires creation of an A-V graft, fistula, or shunt. D. The hemodialysis procedure is performed directly through the bloodstream. E. The hemodialysis procedure is administered through the peritoneal membrane.
B, C, D Rationale: Hemodialysis treatment is administered directly through the bloodstream by way of a vascular access or catheter (short term) or creation of an A-V graft, fistula, or shunt (long term). Peritoneal dialysis involves the use of the peritoneal membrane of the abdominal cavity as a filter and requires implantation of an intra-abdominal catheter.
The nurse is caring for a client with newly diagnosed chronic kidney disease (CKD). Which laboratory value should the nurse expect in this client? (Select all that apply.) A. Normal hemoglobin B. Proteinuria C. High creatinine D. High serum calcium E. Low potassium
B, C, D Rationale: High blood urea nitrogen (BUN) and creatinine, proteinuria, and high serum calcium can all indicate the presence of a renal alteration. Hemoglobin in the client with renal alterations will be decreased. Potassium will be high.
Which assessment finding related to the cardiovascular system should the nurse expect in a client with chronic kidney disease (CKD)? (Select all that apply.) A. Uremic breath B. Altered clotting mechanisms C. Edema D. Petechiae E. Anemia
B, C, E Rationale: Clinical manifestations of CKD related to the cardiovascular system include anemia, altered clotting mechanisms, and edema. Petechiae are a skin change seen in CKD. Uremic breath is a clinical manifestation related to the gastrointestinal system.
The nurse is teaching clients at an outpatient clinic about renal alterations and failure. Which statement regarding alterations in the renal system should the nurse include? (Select all that apply.) A. "Urine output in acute kidney injury will be greater than 50 mL/hr." B. "Chronic kidney disease evolves over years and is irreversible." C. "Recovery will continue for no longer than 3 months." D. "Chronic kidney disease is often hospital associated." E. "Acute kidney injury has a sudden onset and is usually reversible."
B, E Rationale: Acute kidney injury develops suddenly and can usually be reversed with treatment and chronic kidney disease develops over months to years and is generally not reversible. Acute kidney injury is often hospital associated. Urine output is typically less than 30 mL/hr. Recovery will last longer than 6 months.
A client with acute kidney injury (AKI) asks why arterial blood gases (ABGs) are being drawn. Which response should the nurse make? A. "The test can help determine the level of hemoglobin because the failed kidney cannot produce erythropoietin." B. "The test can help determine electrolyte levels in the blood to show the ability of the kidneys to filter blood." C. "The test can help determine acid-base balance in the body, which can be affected by abnormal kidney function." D. "The test can help determine the carbon dioxide level, which can impair the glomerular filtration rate."
C. "The test can help determine acid-base balance in the body, which can be affected by abnormal kidney function." Rationale: ABG testing is used to determine pH, oxygen, and CO2 levels in the blood. Because the kidneys affect excretion of acid and bases, abnormal kidney function can affect acid-base balance. Although the oxygen level (Po2) can be determined with ABGs, the testing cannot directly determine the level of hemoglobin. Serum hemoglobin and hematocrit levels are used to determine the kidney's ability to produce erythropoietin. Serum electrolyte levels are used to determine the ability of the kidneys to filter blood. Although the CO2 level can be determined with an ABG test, the result does not have any direct correlation to the measurement of the glomerular filtration rate.
The nurse is caring for a client with diabetes. Which factor should be considered when the nurse assesses this client's risk for acute kidney injury (AKI)? A. In hospitalized clients, the risk for hospital-associated ARF is greater than 20%. B. The survival of the client depends on dialysis or kidney transplant. C. The incidence of hospital-associated AKI is primarily tied to advanced age. D. The mortality risk is influenced by the client's diabetic condition.
D. The mortality risk is influenced by the client's diabetic condition. Rationale: The mortality rate for AKI ranges from 25% to 90% and is influenced by factors such as age and comorbid conditions, including heart disease and diabetes. The risk for hospital-associated AKI is approximately 9%. The high incidence of hospital-associated AKI is not related to just one factor. It is related to an aging population with an increased risk of AKI, the high prevalence of nephrotoxic exposures possible in a hospital setting and increasing severity of illness. The survival rate of clients in chronic renal failure depends on dialysis or kidney transplant.
The nurse is discussing kidney disease within the older adult population. Which statement should the nurse include? A. "Kidney disease is the most common chronic illness in the geriatric population." B. "The risk of kidney disease is decreased as a client's age increases." C. "Only clients with comorbid conditions are at risk for kidney disease." D. "Older adults have declining kidney function, putting them at increased risk for acute and subsequently chronic kidney disease."
D. "Older adults have declining kidney function, putting them at increased risk for acute and subsequently chronic kidney disease." Rationale: In older adults, acute kidney injury (AKI) incidence increases as renal function declines with age. Older individuals in whom AKI develops are also at risk for chronic kidney disease (CKD). The risk of kidney failure does not decrease with age. Comorbid conditions do contribute to kidney failure, but it can occur in clients who do not have comorbid conditions. CKD is not the most common chronic illness in older adults.
The nurse is teaching a client with acute kidney injury (AKI). Which information should the nurse include? (Select all that apply.) A. Develops because of an obstruction blocking the flow of urine B. Develops as a result of decreased blood supply to the kidney C. Causes damage to the nephrons of the kidney D. Is a progressive, irreversible deterioration in renal function E. Causes waste product buildup leading to uremia
A, B, C Rationale: AKI can happen suddenly as the result of damage to the nephrons of the kidney (intrarenal), decreased or interrupted blood supply to the kidney (prerenal), or obstruction blocking the flow of urine (postrenal). AKI results in buildup of waste products that leads to azotemia, not uremia. Uremia is present in chronic kidney disease (CKD). CKD is a progressive, irreversible deterioration in renal function.
Which intervention should the nurse implement for a client with chronic kidney disease (CKD)? (Select all that apply.) A. Monitor continuous electrocardiogram (ECG) B. Monitor intake and output C. Monitor for infection D. Encourage fluids E. Monitor electrolytes
A, B, C, E Rationale: Nursing care for the client with CKD includes monitoring of electrolyte levels, continuous ECG monitoring, monitoring of intake and output, and monitoring for signs of infection. Fluids would be restricted for the client in renal failure.
The nurse is caring for a group of clients with renal disorders. Which client should the nurse identify as being most at risk for developing chronic kidney disease (CKD)? A. 72-year-old African American man who has glomerulonephritis B. 48-year-old postmenopausal woman who has renal calculi C. 24-year-old woman who is pregnant and has ovarian disease D. 56-year-old Pacific Islander man who smokes and has epididymitis
A. 72-year-old African American man who has glomerulonephritis Rationale: African Americans and American Indians have a higher incidence of chronic kidney disease (CKD) than Caucasian Americans, and Hispanics have a higher incidence than non-Hispanics. African Americans, compared with the general population, also progress more rapidly to end-stage renal disease (ESRD) with consideration for age-associated progression. Outcomes of CKD include complications of decreased kidney function, which include anemia, uremia, derangements of bone and mineral metabolism, cardiovascular disease, and the potential to progress to ESRD. Renal calculi, ovarian disease, and epididymitis do not progress to chronic kidney failure.
Which information should the nurse include when explaining the three phases of acute kidney injury (AKI)? A. Oliguria, diuresis, and recovery B. Initial, progressive, and terminal C. Polyuria, hematuria, and ketonuria D. Acute, recovery, and end stage
A. Oliguria, diuresis, and recovery Rationale: The three phases of AKI are oliguria, diuresis, and recovery. Polyuria, hematuria, and ketonuria are all possible clinical manifestations of diabetes. Acute, recovery, and end stage are not the three phases of AKI. Initial, progressive, and terminal are not phases of AKI.
Which skin change should the nurse expect in a client with acute kidney injury (AKI)? A. Pruritus B. Pulmonary edema C. Confusion D. Anorexia
A. Pruritus Rationale: Pruritus is a skin change seen in uremic syndrome of AKI. Anorexia is a gastrointestinal manifestation of AKI. Confusion is a central nervous system manifestation of AKI. Pulmonary edema is a respiratory manifestation of AKI.
A client with high blood urea nitrogen (BUN) and creatinine has multiple calculi in the right kidney. Which type of renal injury should the nurse suspect in this client? A. Intrinsic B. Prerenal C. Postrenal D. Intrarenal
C. Postrenal Rationale: Postrenal injury occurs as a result of obstruction of urine flow, such as that caused by stones, benign prostatic hypertrophy, or tumors. Prerenal injury is a type of renal failure that results from decreased renal blood flow, such as that seen in hypovolemia, dehydration, sepsis, or heart failure. Intrinsic renal injury occurs related to nephrotoxic exposure, glomerulonephritis, sepsis, vasculitis, and ischemia within the kidney. Intrarenal is not a term used for acute kidney injury.
A client with acute kidney injury has chronic systolic heart failure that has affected kidney function. In which way should the nurse categorize this type of the kidney injury? A. Intrinsic B. Postrenal C. Prerenal D. Intrarenal
C. Prerenal Rationale: The cause is prerenal injury due to decreased cardiac output. Prerenal injury is a type of injury that results from decreased renal blood flow, such as that seen in hypovolemia, dehydration, sepsis, or heart failure. Intrinsic renal injury occurs related to nephrotoxic exposure, glomerulonephritis, sepsis, vasculitis, and ischemia within the kidney. Postrenal injury occurs as a result of obstruction of urine flow such as that caused by stones, benign prostatic hypertrophy, or tumors. Intrarenal is not a term used for acute kidney injury.
Which substance should the nurse identify that could increase a client's risk of acute intrinsic kidney injury? A. Caffeine B. Nicotine C. Acetaminophen D. Contrast dye
D. Contrast dye Rationale: Contrast dye can increase the risk of intrinsic kidney injury. Acetaminophen contributes to liver failure. Nicotine can cause vasoconstriction and contribute to hypertension, which would increase the risk of chronic kidney disease. Caffeine is not associated with renal injury.
