Acute Renal Injury & CKD - NCLEX

Which assessment finding is commonly found in the oliguric phase of acute kidney injury (AKI)? A. Hypovolemia B. Hyperkalemia C. Hypernatremia D. Thrombocytopenia

B. Hyperkalemia In AKI, the serum potassium levels increase because the normal ability of the kidneys to excrete potassium is impaired. Sodium levels are typically normal or diminished, whereas fluid volume is normally increased due to decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.

What are the main advantages of peritoneal dialysis compared to hemodialysis? A. No medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. B. The diet is less restricted and dialysis can be performed at home. C. The dialysate is biocompatible and causes no long-term consequences. D. High glucose concentrations of the dialysate cause a reduction in appetite, promoting weight loss.

B. The diet is less restricted and dialysis can be performed at home. Advantages of peritoneal dialysis include fewer dietary restrictions and home dialysis is possible.

The patient in the oliguric phase of AKI excreted 300 mL of urine in addition to 100 mL of other losses during the past 24 hours. With appropriate calculations, you determine that for the next 24 hours the patient's fluid allocation is A. 600 mL. B. 800 mL. C. 1000 mL. D. 1200 mL.

C. 1000 mL. Fluid intake must be closely monitored during the oliguric phase. The rule for calculating the fluid restriction is to add all losses for the previous 24 hours to 600 mL for insensible losses.

If a patient is in the diuretic phase of AKI, you must monitor for which serum electrolyte imbalances? A. Hyperkalemia and hyponatremia B. Hyperkalemia and hypernatremia C. Hypokalemia and hyponatremia D. Hypokalemia and hypernatremia

C. Hypokalemia and hyponatremia In the diuretic phase of AKI, the kidneys have recovered their ability to excrete wastes but not to concentrate the urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

A patient is recovering in the intensive care unit (ICU) after receiving a kidney transplant approximately 24 hours earlier. What is an expected assessment finding for this patient during the early stage of recovery? A. Hypokalemia B. Hyponatremia C. Large urine output D. Leukocytosis with cloudy urine output

C. Large urine output Patients frequently experience diuresis in the hours and days immediately after kidney transplantation. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

How should you assess the patency of a newly placed arteriovenous graft for dialysis? A. Irrigate the graft daily with low-dose heparin. B. Monitor for any increase in blood pressure in the affected arm. C. Listen with a stethoscope over the graft for presence of a bruit. D. Frequently monitor the pulses and neurovascular status distal to the graft.

C. Listen with a stethoscope over the graft for presence of a bruit. A thrill can be felt by palpating the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein.

You are caring for a patient receiving continuous replacement therapy and notice that the filtrate is blood tinged. What is your priority action? A. Place the patient in Trendelenburg position. B. Initiate a peripheral intravenous line. C. Suspend treatment immediately. D. Administer vitamin K (Aquamephyton) per order.

C. Suspend treatment immediately. The ultrafiltrate should be clear yellow, and specimens may be obtained for evaluation of serum chemistries. If the ultrafiltrate becomes bloody or blood tinged, a possible rupture in the filter membrane should be suspected, and treatment is suspended immediately to prevent blood loss and infection.

The patient admitted to the intensive care unit after a motor vehicle accident has been diagnosed with AKI. Which finding indicates the onset of oliguria resulting from AKI? A. Urine output less than 1000 mL for the past 24 hours B. Urine output less than 800 mL for the past 24 hours C. Urine output less than 600 mL for the past 24 hours D. Urine output less than 400 mL for the past 24 hours

D. Urine output less than 400 mL for the past 24 hours The most common initial manifestation of AKI is oliguria, a reduction to urine output to less than 400 mL/day.

For the patient with AKI, which laboratory result would cause you the greatest concern? A. Potassium level of 5.9 mEq/L B. BUN level of 25 mg/dL C. Sodium level of 144 mEq/L D. pH of 7.5

A. Potassium level of 5.9 mEq/L Hyperkalemia is one of the most serious complications in AKI because it can cause life-threatening cardiac dysrhythmias.

What characterizes AKI (select all that apply)? A. Primary cause of death is infection. B. It usually affects older people. C. The disease course is potentially reversible. D. The most common cause is diabetic nephropathy. E. Cardiovascular disease is the most common cause of death.

A. Primary cause of death is infection. C. The disease course is potentially reversible. AKI is potentially reversible. It has a high mortality rate, and the primary cause of death is infection; the primary cause of death for chronic kidney failure is cardiovascular disease. AKI commonly follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Although it can occur at any age, the older adult is more susceptible to AKI because the number of functioning nephrons decreases with age.

Your plan for care of a patient with AKI includes which goal of dietary management? A. Provide sufficient calories while preventing nitrogen excess. B. Deliver adequate calories while restricting fat and protein intake. C. Replace protein intake with enough fat intake to sustain metabolism. D. Restrict fluids, increase potassium intake, and regulate sodium intake.

A. Provide sufficient calories while preventing nitrogen excess. The challenge of nutrition management in AKI is to provide adequate calories to prevent catabolism despite the restrictions required to prevent electrolyte and fluid disorders and azotemia (accumulation of nitrogen and wastes in blood).

Which patient has the greatest risk for prerenal AKI? A. The patient is hypovolemic because of hemorrhage. B. The patient relates a history of chronic urinary tract obstruction. C. The patient has vascular changes related to coagulopathies. D. The patient is receiving antibiotics such as gentamicin.

A. The patient is hypovolemic because of hemorrhage. Prerenal causes of AKI are factors external to the kidneys. These factors reduce systemic circulation, causing a reduction in renal blood flow, and they lead to decreased glomerular perfusion and filtration of the kidneys.

Important nursing interventions for the patient with AKI are (select all that apply) A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. D. increase intake of vitamin A and D. E. frequent mouth care.

A. careful monitoring of intake and output. B. daily patient weights. C. meticulous aseptic technique. E. frequent mouth care. You have an important role in managing fluid and electrolyte balance during the oliguric and diuretic phases of AKI. Observing and recording accurate intake and output are essential. Measure daily weights with the same scale at the same time each day to assess excessive gains or losses of body fluids. Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membrane.

During the oliguric phase of AKI, you monitor the patient for (select all that apply) A. hypertension. B. electrocardiographic (ECG) changes. C. hypernatremia. D. pulmonary edema. E. urine with high specific gravity.

A. hypertension. B. electrocardiographic (ECG) changes. D. pulmonary edema. You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (anuria and oliguria), the neck veins may become distended and have a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions. The patient is monitored for hyponatremia. Damaged tubules cannot conserve sodium, and the urinary excretion of sodium may increase, resulting in normal or below-normal levels of serum sodium. Monitoring may reveal ECG changes and hyperkalemia. Initially, clinical signs of hyperkalemia are apparent on electrocardiogram, which demonstrate peaked T waves, widening of the QRS complex, and ST-segment depression. Urinary specific gravity is fixed at about 1.010.

When caring for a patient during the oliguric phase of acute kidney injury, what would be an appropriate nursing intervention? A. Weigh patient three times weekly B. Increase dietary sodium and potassium C. Provide a low-protein, high-carbohydrate diet D. Restrict fluids according to the previous day's fluid loss

D. Restrict fluids according to the previous day's fluid loss Patients in the oliguric phase of acute kidney injury have fluid volume excess with potassium and sodium retention. They will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times per week.