AKI evolve questions
Which statements made by the nurse indicate an understanding of patient care during hemodialysis? Select all that apply. 1 "I should auscultate the lungs." 2 "I should record the body temperature." 3 "I should check the mouth for bad breath." 4 "I should monitor the level of consciousness." 5 "I should monitor the access site for discharge."
"I should auscultate the lungs." "I should record the body temperature." "I should monitor the level of consciousness." "I should monitor the access site for discharge."
The nursing instructor is evaluating the statements of a student nurse about medication safety for patients with acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "I should warn the patient about the use of over-the-counter-drugs." 2 "I should suggest that patients limit the course of antibiotics prescribed." 3 "I should instruct patients to go for a follow-up medical checkup every six months." 4 "I should instruct patients to take antihypertensives if their blood pressure increases."
"I should warn the patient about the use of over-the-counter-drugs." Over-the-counter drugs are harmful to the kidneys for patients with preexisting kidney disease and may worsen the symptoms. For example, acetaminophen causes nephrotoxicity and, if overused, may cause kidney failure. An antibiotic course should be completed and not limited because the patient may develop resistance. Patients with renal impairment should visit the health care center regularly to help in the early detection or treatment of further complications associated with chronic kidney disease. Angiotensin-converting enzyme inhibitors are used as antihypertensives and should be taken only when prescribed by a health care provider because of the side effect of hyperkalemia.
The registered nurse is teaching a student nurse about parenteral nutrition in patients with kidney disease. Which statement by the student nurse indicates the need for further teaching? 1 "Fat emulsion intravenous infusions can be given." 2 "It is given to patients with functional gastrointestinal tract." 3 "The patient needs daily hemodialysis when on parenteral nutrition." 4 "Concentrated formulas of parenteral nutrition can be given to patients with renal failure."
"It is given to patients with functional gastrointestinal tract." Parenteral nutrition is given to patients who have a nonfunctional gastrointestinal tract. Fat emulsion intravenous infusions can be given as a source for non-protein calories. Patients on parenteral nutrition require daily hemodialysis to remove excess fluids. Patients with kidney failure can receive concentrated formulas of parenteral nutrition because they minimize fluid volume.
Which statement by the nurse indicates an understanding of the indications for renal replacement therapy (RRT)? 1 "RRT is indicated for patients with hypokalemia." 2 "RRT is effective for patients with metabolic acidosis." 3 "RRT is recommended for patients with hypovolemia." 4 "RRT is recommended in the case of pericardial effusion."
"RRT is recommended in the case of pericardial effusion." Pericardial effusion is an abnormal accumulation of fluid inside the pericardial cavity; this condition is caused by increased blood volume. Renal replacement therapy (RRT) is recommended because the kidneys are unable to function properly. RRT is recommended in hyperkalemic, not hypokalemic, conditions. RRT does not alleviate the effects of metabolic alkalosis. RRT is advised in patients with fluid overload, not hypovolemia.
The registered nurse is teaching a student nurse about physiologic changes in the diuretic phase of a patient with acute kidney disease. Which statement by the student nurse about the diuretic phase indicates effective learning? Select all that apply. 1 "The diuretic phase lasts for one to three weeks." 2 "Urine volume decreases in the diuretic phase." 3 "Hypovolemia occurs during the diuretic phase." 4 "The kidneys will have the ability to concentrate urine." 5 "The creatinine level increases drastically at the end of the diuretic phase."
"The diuretic phase lasts for one to three weeks." "Hypovolemia occurs during the diuretic phase." The diuretic phase lasts for one to three weeks and hypovolemia and hypotension occur due to increased urinary output. In the diuretic phase, urine output increases because of the renal tubules' inability to concentrate urine. At the end of the diuretic phase, the creatinine, blood urine nitrogen, and electrolyte levels return to normal.
The nursing instructor is teaching a student nurse about sodium polystyrene sulfonate. Which statement by the student nurse indicates the need for further teaching? 1 "It can be administered as an enema." 2 "The drug is effective in treating a paralytic ileus." 3 "The drug helps exchange potassium for sodium." 4 "It is mixed in water with sorbitol and then administered."
"The drug is effective in treating a paralytic ileus." Sodium polystyrene sulfonate is used to correct hyperkalemia and is contraindicated in patients with a paralytic ileus because it causes bowel necrosis. Sodium polystyrene sulfonate can be administered in the form of an enema, which acts by exchanging potassium for sodium ions. It can also be administered after mixing it in water with sorbitol to facilitate the removal of potassium from the body.
The patient admitted with sepsis is at risk of developing what renal pathology? 1 Nephritis 2 Glomerular nephritis 3 Acute tubular necrosis 4 Chronic kidney disease
Acute tubular necrosis Acute tubular necrosis is a result of an acute shock on the renal system and is recoverable, but the patient is likely to develop acute kidney impairment (AKI). Nephritis is an acute infection of the nephrons. Glomerular nephritis develops into chronic kidney disease and is not a result of sepsis.
The nurse is teaching a patient with acute kidney injury about lifestyle modifications. Which actions by the patient indicate effective teaching? 1 Consuming less salt 2 Eating foods rich in protein 3 Increase intake of fluids 4 Consuming potassium-rich foods
Consuming less salt Sodium causes fluid and water retention and thereby increases blood volume; thus, the patient should consume less salt. Patients with renal impairment should decrease protein intake because proteins break down into urea, which is dangerous if it accumulates in the brain. Increasing the intake of fluid will increase the volume of fluid in the body. Because the kidney function is impaired, excess fluid cannot be eliminated and it accumulates in the body, leading to edema and congestive cardiac failure. Kidney disease is associated with hyperkalemia; thus eating potassium-rich food will worsen the condition and may lead to cardiac arrhythmia.
The nurse knows the patient with acute kidney injury (AKI) has entered the diuretic phase when what assessments occur? Select all that apply. 1 Dehydration 2 Hypokalemia 3 Hypernatremia 4 Serum creatinine increases 5 Blood urea nitrogen (BUN) increases
Dehydration Hypokalemia Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes, but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease.
The patient was diagnosed with prerenal acute kidney injury (AKI). The nurse should know that what is most likely the cause of the patient's diagnosis? 1 Intravenous (IV) tobramycin 2 Incompatible blood transfusion 3 Poststreptococcal glomerulonephritis 4 Dissecting abdominal aortic aneurysm
Dissecting abdominal aortic aneurysm A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststreptococcal glomerulonephritis are intrarenal causes of AKI.
While caring for a patient with acute kidney injury, the nurse observes that the patient has hand tremors while extending the wrist. The patient's laboratory report shows a blood urea nitrogen (BUN) level of 123 mg/dL. Which action by the patient does the nurse suspect as the cause of this symptom? 1 Eating protein-rich food 2 Eating sodium-rich food 3 Eating potassium-rich food 4 Eating carbohydrate-rich food
Eating protein-rich food Patients with acute kidney injury have impaired renal excretion cannot eliminate nitrogenous wastes; this will result in increased blood urea nitrogen (BUN) levels. Eating protein-rich food will increase the level of BUN and cause neurologic changes such as asterixis, which is characterized by flapping tremor upon extension of the wrist. A normal level of BUN is 120 mg/dL. Because the patient has asterixis and a BUN level of 125 mg/dL, the nurse suspects the consumption of protein-rich food to be the cause of this symptom, not the consumption of sodium-rich, potassium-rich, or carbohydrate-rich food.
The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1 Normal creatinine level 2 Decreased sodium level 3 Decreased potassium level 4 Elevated blood urea nitrogen (BUN)
Elevated blood urea nitrogen (BUN) The patient with heart failure has a decreased circulating blood volume. This causes autoregulatory mechanisms to preserve blood flow to essential organs. Laboratory data for this patient will likely demonstrate an elevation in BUN, creatinine, and potassium. Prerenal azotemia results in a reduction in the excretion of sodium, increased sodium and water retention, and decreased urine output.
A 72-year-old African American male with a history of chronic hypertension, coronary artery disease, and type II diabetes presents to the emergency room with complaints of shortness of breath and difficulty urinating. Upon review of test results, what is the best indicator of acute renal failure? 1 Elevated serum creatinine levels 2 Elevated serum blood urea nitrogen (BUN) 3 Elevated serum pH on the arterial blood gases (ABGs) 4 Hydronephrosis on the computed tomography (CT) scan
Elevated serum creatinine levels The best indicator of level of renal functioning is the serum creatinine level. Elevated creatinine levels indicate renal failure. Hydronephrosis, or swelling of the kidney, may occur with obstructive processes such as renal calculi, but this is not an exclusive indicator of renal function. Elevated serum BUN levels may result from a variety of problems, including dehydration, severe injury, catabolic states, gastrointestinal (GI) bleeding, or renal failure. An elevated pH indicates acid-base imbalance, not necessarily renal failure.
The nurse is caring for a patient with severe burns in the emergency department. His laboratory values reveal serum creatinine level of 5 mg/dL, and the glomerular filtration rate (GFR) has decreased by 75%. What stage of acute kidney failure is this patient exhibiting? 1 Risk 2 Injury 3 Failure 4 Loss
Failure As per the RIFLE (Risk, Injury, Failure, Loss, and End-stage) classification for staging acute kidney injury, this patient is at the Failure stage. When the GFR has decreased by 25%, the patient is at the Risk stage. The patient with a GFR that has decreased by 50% is at the Injury stage. The patient with persistent acute kidney failure experiences a complete loss of kidney function and is at the Loss stage.
A patient with acute kidney injury has hypovolemia. After an intravenous infusion of fluids, the nurse observes that the patient has no urine output and a blood pressure of 140/90 mm Hg. Which risk does the nurse anticipate in this patient? 1 Gall stones 2 Lung failure 3 Heart failure 4 Liver damage
Heart failure Heart failure is caused by an increase in the circulatory volume. An observation of a lack of urine output and increased blood pressure indicates a buildup of fluid in the body, and the patient is at risk of heart failure. Gallstones are caused by increased levels of cholesterol in the bile or an inability of the gallbladder to empty properly. Conditions such as pneumonia and chronic obstructive pulmonary disease decrease the amounts of air and blood that enter and exit the lungs, causing lung failure. Increased levels of liver enzymes are signs of liver damage.
What is an intrarenal cause of acute kidney injury? 1 Renal artery thrombosis 2 Neuromuscular disorders 3 Benign prostatic hyperplasia 4 Hemolytic blood transfusion reaction
Hemolytic blood transfusion reaction Hemolytic blood transfusion reaction is an intrarenal cause of acute kidney injury. Renal artery thrombosis is a prerenal cause of acute kidney injury. Neuromuscular disorders and benign prostatic hyperplasia are postrenal causes of acute kidney injury.
While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? 1 Hyperkalemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperchloremia
Hyperkalemia Hyperkalemia is associated with electrocardiographic changes like T-wave elevation, widening of the QRS complex, and ST-segment depression. A short QT interval and a small ST segment indicate hypercalcemia. Hypernatremia is characterized by a flat T wave. A depressed T wave is a characteristic of hyperchloremia.
Which assessment finding is a consequence of the oliguric phase of acute kidney injury (AKI)? 1 Hypovolemia 2 Hyperkalemia 3 Hypernatremia 4 Thrombocytopenia
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 because of decreased urine output. Thrombocytopenia is not a consequence of AKI, although altered platelet function may occur in AKI.
What are the common causes of acute kidney injury? Select all that apply. 1 Hypovolemia 2 Interstitial nephritis 3 Increased cardiac output 4 Decreased renovascular blood flow 5 Increased peripheral vascular resistance
Hypovolemia Interstitial nephritis Decreased renovascular blood flow Acute kidney injury is defined as rapid loss of kidney function. The common causes of acute renal injury are prerenal, intrarenal, and postrenal. One cause of acute kidney injury is hypovolemia, which is associated with dehydration, diarrhea, burns, and hemorrhage. Interstitial nephritis, which is associated with allergies and infections, is another cause of acute kidney injury. Decreased renovascular blood flow, which is associated with embolism and renal artery thrombosis, is another cause of acute kidney injury. Decreased cardiac output, which is associated with cardiac dysrhythmias and cardiogenic shock, is also a cause of acute kidney injury. Decreased peripheral vascular resistance, which is associated with neurologic injury and septic shock, is another cause of acute kidney injury.
A patient has renal failure. The nurse, reviewing the lab results, recognizes which finding as indicative of the diminished renal function associated with the diagnosis? 1 Hypokalemia 2 Increased serum urea and serum creatinine 3 Anemia and decreased blood urea nitrogen 4 Increased serum albumin and hyperkalemia
Increased serum urea and serum creatinine Renal failure, whether acute or chronic, causes an increase in serum urea, creatinine, and blood urea nitrogen. Renal failure may also cause hyperkalemia and anemia and decrease serum albumin. However, it does not cause decreased blood urea nitrogen or increased serum albumin.
A patient complains of reduced urine output and abdominal pain. The primary health care provider suspects acute kidney injury. Which diagnostic test will the health care provider suggest as an initial test to confirm the diagnosis? 1 Renal biopsy 2 Kidney ultrasound 3 Computed topographic scan 4 Magnetic resonance imaging
Kidney ultrasound Aside from blood tests, the health care provider will first order a kidney ultrasound because it does not involve exposure to contrast agents. A renal biopsy is the best method for confirmation of intrarenal causes of acute kidney injury; however, it is not the preliminary test used to diagnose acute kidney injury. A computed tomographic scan can identify lesions, masses, obstructions, and vascular anomalies, but it is not primarily used to establish a diagnosis of acute kidney injury. Magnetic resonance imaging will be suggested later to examine the abnormalities in detail.
Which condition is a result of severe metabolic acidosis in patients with acute kidney injury? 1 Asterixis 2 Proteinuria 3 Hydronephrosis 4 Kussmaul respirations
Kussmaul respirations Severe acidosis causes a patient to take deep and rapid breaths—called Kussmaul respirations—in an effort to increase the exhalation of carbon dioxide. Asterixis is a neurologic change associated with acute kidney injury due to the accumulation of metabolic waste in the brain and nervous system. Dysfunction of the glomerular membrane due to acute kidney injury leads to proteinuria. Hydronephrosis refers to dilation of the kidneys and is a postrenal cause of acute kidney injury.
The patient has a form of glomerular inflammation that is progressing rapidly. The patient is gaining weight, and the urine output is declining steadily. What is the priority nursing intervention? 1 Monitor the patient's cardiac status. 2 Teach the patient about hand washing. 3 Increase direct observation of the patient. 4 Obtain a serum specimen for electrolytes.
Monitor the patient's cardiac status. The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as prescribed by the health care provider.
A primary health care provider has ordered frequent magnetic resonance imaging using a gadolinium contrast agent in a patient with kidney failure. The patient reports darkness of the skin, joint pain, and limited joint movement. What condition does the nurse suspect? 1 Asterixis 2 Hydronephrosis 3 Nephrogenic systemic fibrosis 4 Contrast-induced nephropathy
Nephrogenic systemic fibrosis Nephrogenic systemic fibrosis is caused by the administration of gadolinium to patients with kidney failure; signs include hyperpigmentation of the skin and joint contractures. Asterixis is characterized by a tremor-like condition upon stretching of the wrist. Hydronephrosis is caused by bilateral ureteral obstruction. Contrast-induced nephropathy is a kidney injury caused by the injection of contrast agents during surgery or diagnostic testing.
Which statement about acute kidney injury is correct? 1 Parenchymal damage occurs in prerenal oliguria. 2 Prerenal azotemia results in increased sodium excretion. 3 Prerenal oliguria is caused by decreased circulatory volume. 4 Prerenal causes of acute kidney injury increase the glomerular filtration rate.
Prerenal oliguria is caused by decreased circulatory volume. Prerenal oliguria is caused by a decrease in the circulatory volume due to dehydration and congestive cardiac failure. Parenchymal damage does not occur in prerenal oliguria. Prerenal azotemia results in decreased sodium excretion, which leads to increased sodium and water retention. Reduced systemic circulation is a prerenal cause that leads to a decrease in the blood flow to the kidneys. Therefore the glomerular filtration rate also decreases.
Which nursing intervention should the nurse implement while preparing a high-risk patient with contrast-induced nephropathy for magnetic resonance imaging? 1 Give low-fat foods 2 Give low-calorie foods 3 Provide plenty of fluids 4 Provide a high-protein diet
Provide plenty of fluids Contrast agents accumulate in the nephrons, causing their death and resulting in renal failure. Therefore patients who have a high risk of contrast-induced nephropathy should be well hydrated. Fatty foods are rich in calories and should be given to provide energy. High-calorie foods should be included in a patient's diet. A high-protein diet causes increased levels of nitrogenous waste in the blood. Therefore a low-protein diet should be given to this patient.
While caring for a patient with kidney failure, the patient has three episodes of vomiting and diarrhea. Which action should the nurse perform as a priority? 1 Administer antiemetic. 2 Record the blood pressure. 3 Record the volume of fluid lost. 4 Administer water with a high salt content.
Record the volume of fluid lost. The nurse should record the volume of fluid lost as a priority because replacement must be done to prevent tubular damage. The nurse should not administer drugs without consulting the primary health care provider. The blood pressure should be recorded to check for hypovolemia, but this action can also be performed later. The nurse should not administer salty water because it can induce vomiting.
What causes prerenal acute kidney injury? 1 Release of nephrotoxins 2 Reduced renal blood flow 3 Urine reflux into renal pelvis 4 Presence of extrarenal tumors
Reduced renal blood flow Prerenal acute kidney injury can be caused by a reduced flow of blood to the kidneys. A release of nephrotoxins is an intrarenal cause of acute kidney injury. Urine reflux into the renal pelvis and the presence of extrarenal tumors are postrenal causes of acute kidney injury.
When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention? 1 Weigh patient three times weekly. 2 Increase dietary sodium and potassium. 3 Provide a low-protein, high-carbohydrate diet. 4 Restrict fluids according to previous daily loss.
Restrict fluids according to previous daily loss. Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention. Therefore they will need to have dietary sodium, potassium, and fluids restricted. The patient also should be weighed daily, not just three times each week. 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.
Which finding indicates oliguria? 1 Urinary output of 350 mL/day 2 Urinary output of 450 mL/day 3 Urinary output of 550 mL/day 4 Urinary output of 650 mL/day
Urinary output of 350 mL/day A urinary output rate of less than 400 mL/day indicates oliguria; thus a urinary output of 350 mL/day suggests oliguria. Urine outputs of 450, 550, or 650 mL/day are considered normal.
