Ch. 46- Learning: Acute Kidney Injury and Chronic Kidney Disease

Impaired release of which substance should the nurse know contributes to anemia in patients with chronic kidney disease? A. Erythropoietin B. Estrogen C. Renin D. Cortisol

A. Erythropoietin - Erythropoietin, which stimulates RBC production, is decreased in patients with CKD. - Estrogen is a hormone that is an integral component of the menstrual cycle. - Renin is released as a result of altered renal perfusion to stimulate vasoconstriction and water and sodium retention. - Cortisol is a stress hormone released from the adrenal gland.

A patient has an abrupt decrease in glomerular filtration rate (GFR) and urine output. Which item should the nurse expect to be used to plan care for this patient? A. RIFLE criteria B. Subjective symptoms C. Admission assessment D. Laboratory data

A. RIFLE criteria - RIFLE stands for Risk, Injury, Failure, Loss, and End-stage renal disease. It is a staging system, or tool, used to determine the criteria for classifying and treating acute kidney injury on the basis of glomerular filtration rate (GFR) and urine output. - The admission assessment, laboratory data, and subjective symptoms will contribute to the plan of care; however, RIFLE criteria is the tool used for a patient with end-stage renal disease.

Which statement about acute tubular necrosis should the nurse know is correct? A. "It is commonly caused by lack of oxygen to the kidney." B. "It is the result of extracellular growth around the renal tubule." C. "It is the accumulation of waste products of homeostasis." D. "It is always the cause of most cases of acute kidney injury."

A. "It is commonly caused by lack of oxygen to the kidney." - The most common reason for admission to the hospital for renal alterations is acute tubular necrosis (ATN). ATN results from damage to the renal tubular epithelium caused by a nephrotoxic (intrarenal) or ischemic (prerenal) injury. Damage to the epithelium prevents normal concentration of urine, filtration of waste products, regulation of the acid-base balance, electrolyte hemostasis, and fluid balance.

A patient with acute kidney injury (AKI) has an elevated sodium level. Which finding should the nurse expect to assess in this patient? A. Joint pain B. Hunger C. Edema D. Thirst

C. Edema - Increased sodium retention causes water retention, which causes edema. - Hunger, thirst, and joint pain are not associated with an elevated sodium level.

Which type of diet should the nurse expect to be prescribed for a patient with chronic kidney disease (CKD)? A. Low-calcium B. High-potassium C. Low-potassium D. Low-fat

C. Low-potassium - A low-potassium diet helps decrease the albumin level in the blood; a high level of albumin will cause further renal damage and impair the kidney's ability to balance electrolytes and can lead to hyperkalemia, hypocalcemia, and hyperphosphatemia. - A diet high in potassium would be discouraged because of the potential for hyperkalemia. - A low-fat diet would be beneficial but will not have a direct effect on electrolyte balance. - A diet low in calcium would not address hypocalcemia.

The nurse attends a class regarding the RIFLE criteria. Which statement should the nurse make about the criteria? A. "It is the tool used to determine GFR." B. "It is diagnostic criteria for standardizing treatment for AKI." C. "It is diagnostic criteria used to define complications of chronic kidney disease." D. "It is a set of criteria for the staging of renal cancer."

B. "It is diagnostic criteria for standardizing treatment for AKI." RIFLE stands for Risk, Injury, Failure, Loss, and End-stage renal disease. It is a staging system, or tool, used to determine the criteria for classifying and treating acute kidney injury on the basis of glomerular filtration rate (GFR) and urine output. Staging for renal cancer is conducted with the TNM (Tumor, Node, Metastasis) system. It is not used to define complications related to chronic kidney disease, nor is it used to calculate GFR.

A patient is experiencing adverse effects from chronic anemia. For which health problem should the nurse plan care for this patient? A. Acute kidney injury (AKI) B. Chronic kidney disease (CKD) C. Hypertension D. Renal calculi

B. Chronic kidney disease (CKD) - Anemia is caused by decreased production of erythropoietin that occurs in CKD. - Chronic anemia is not associated with AKI, hypertension, or renal calculi.

The nurse is assessing a patient in the diuretic phase of acute kidney injury (AKI). Which finding should the nurse expect? A. Urine output of 1 to 2 L/day B. Decreased potassium levels C. Urine output under 400 mL/day D. Hypervolemia

B. Decreased potassium levels - Decreased potassium, sodium, and water levels are symptoms of the diuretic phase of AKI. - Urine output of 1 to 2 L/day is expected during the recovery phase of AKI. - Hypervolemia and weight gain are symptoms during the oliguric phase of AKI. - A decrease in urine output to less than 400 mL/day is also a symptom of the oliguric phase of AKI.

The nurse is caring for a patient with chronic kidney disease (CKD) and anemia. Which medication should the nurse anticipate being prescribed for this patient? A. Vitamin B12 B. Erythropoietin-stimulating agents C. Ferrous sulfate D. Folic acid

B. Erythropoietin-stimulating agents - Erythropoietin-stimulating agent is used to address the decreased production and release of erythropoietin. - Ferrous sulfate, vitamin B12, and folic acid can be used to treat anemia, but anemia due to CKD is a result of decreased erythropoietin.

A patient with hypertension and elevated blood glucose levels has albuminuria and reduced glomerular filtration rate caused by chronic kidney disease (CKD). For which factor should the nurse review this patient's medical record? A. Development of fibrosis in the kidney B. Family history of kidney disease C. Exposure to environmental factors D. Enhanced nephron capability and function

B. Family history of kidney disease - Although diabetic nephropathy is the leading cause of CKD, a familial predisposition will most likely increase the risk for this disorder. - Fibrosis in the kidney can cause CKD as a result of the development of chronic glomerulonephritis. - Consistent exposure to environmental factors is not a considerable risk factor for CKD. - Enhanced nephron capability does not lead to CKD.

The nurse is completing a medical history and physical examination of a patient with suspected chronic kidney disease (CKD). Which modifiable risk factor(s) should the nurse plan to address with the patient? A. Genetic predisposition B. Obesity and hypertension C. Ethnicity and age D. History of premature birth

B. Obesity and hypertension - Obesity and age are modifiable risk factors for CKD. - Ethnicity, age, genetic predisposition, and history of premature birth are all risk factors that cannot be modified.

The nurse is caring for a patient who has dehydration, oliguria, and a urine output of <0.5 mL/kg/hr in the last 6 hours. Which type of acute kidney injury (AKI) should the nurse suspect? A. Intrinsic B. Prerenal C. Intrarenal D. Postrenal

B. Prerenal - Dehydration is a primary cause of prerenal AKI and the nurse should monitor intake and output in a patient to assess for risk of developing this disorder. - Intrinsic causes would include ischemia and nephrotoxins. - Postrenal causes would include tumors and obstructions. - Intrarenal is not a term used in relationship with AKI.

A patient with a history of hypertension develops hypertensive crisis. For which health problem should the nurse monitor this patient? A. Intrinsic AKI B. Prerenal acute kidney injury (AKI) C. Increased glomerular filtration rate (GFR) D. Acute pyelonephritis

B. Prerenal acute kidney injury (AKI) - Antihypertensive medications and diuretics are the main contributors to prerenal AKI because they reduce perfusion in the kidneys. - Intrinsic AKI is caused by medications that result in tubular necrosis, and acute pyelonephritis represents possible causes of intrarenal AKI. - Though GFR may possibly be reduced in a patient taking certain medications, this is not the primary reason for monitoring the patient for prerenal AKI.

The nurse is caring for a patient with postrenal acute kidney injury (AKI). Which health history information should the nurse expect to find in the patient's chart? A. Septicemia B. Renal calculi C. Crush injury D. Heart attack

B. Renal calculi - Postrenal AKI is caused by obstruction of urine outflow, such as that seen in people with renal calculi. - Precipitating factors may include myocardial infarction and sepsis. - Crush injury is a risk factor for intrarenal, not postrenal, AKI.

The nurse reviews the health histories of patients with acute kidney injury (AKI) and chronic kidney disease (CKD). Which health problem should the nurse identify that increases a patient's chances for a kidney transplant? A. Cancer B. Active infection C. AIDS D. Congenital kidney disease

D. Congenital kidney disease - Kidney transplantation is suggested for patients who will be compliant and have the potential for a high quality of life after transplantation. Therefore, a patient with congenital kidney disease would qualify for a kidney transplant. - Active infection, cancer, and AIDS would all exclude a patient from kidney transplantation.

A patient with Mycobacterium tuberculosis is being treated with gentamicin, an aminoglycoside antibiotic. The patient develops acute tubular necrosis. Which statement should the nurse use to explain the development of this condition? A. "Acute kidney injury is always caused by autoimmune disorders, not bacterial infections." B. "Acute kidney injury is caused by obstruction of the ureter or bladder." C. "Acute kidney injury is often caused by exposure to toxic substances that result in ischemia and by prolonged prerenal causes such as decreased perfusion to the kidney." D. "When it's the result of prolonged bacterial infection, acute kidney injury always requires dialysis for the duration of the patient's life."

C. "Acute kidney injury is often caused by exposure to toxic substances that result in ischemia and by prolonged prerenal causes such as decreased perfusion to the kidney." - Acute kidney injury (AKI) is caused by ischemia and prolonged prerenal hypoperfusion, which is often a result of the toxicity of nephrotoxic agents such as aminoglycoside antibiotics. - AKI does not always necessitate dialysis for the duration of the patient's life. - Obstructions of the ureter or bladder constitute postrenal acute kidney injury. - Autoimmune deposits can cause glomerulonephritis, but this is an inflammation of the glomeruli and a cause of intrinsic acute kidney injury, which may cause AKI, but this is not always the cause.

An older patient with a history of acute kidney injury (AKI) has azotemia. Which statement should the nurse make that explains the need to monitor this patient for chronic kidney disease (CKD)? A. "It is important to monitor to ensure that there is evidence of a relationship between AKI and CKD." B. "All patients who are found to have AKI will progress to CKD." C. "Older adults with AKI are more likely to have CKD." D. "The risk of CKD resulting from AKI is decreased in the geriatric population."

C. "Older adults with AKI are more likely to have CKD." Because of the diminished glomerular filtration rate that occurs with aging, older adults who experience AKI are at higher risk for CKD. There is evidence that AKI can increase the risk of CKD, especially in patients who are older or have comorbid conditions that may affect the kidneys. However, not all patients who have AKI will progress to CKD. The risk of CKD resulting from AKI is not markedly decreased in the geriatric population.

The nurse is teaching a patient about the relationship between anemia and chronic kidney disease. Which explanation should the nurse include? A. "Anemia develops because the kidney destroys the red blood cells." B. "The kidney isn't able to release renin, which is responsible for making red blood cells." C. "There's a decrease in erythropoietin production because it is made in the kidney." D. "You may become anemic because the kidney will use more red blood cells for oxygen."

C. "There's a decrease in erythropoietin production because it is made in the kidney." - Anemia in chronic kidney disease occurs as a result of decreased production of erythropoietin. - Red blood cells (RBCs) are not destroyed in the kidney. - Renin is not responsible for RBC production. - The kidneys do not use more RBCs; there is a lack of RBC production.

The nurse reviews information about assigned patients. Which patient should the nurse recognize as being at the highest risk for chronic kidney disease (CKD)? A. A 60-year-old Hispanic woman admitted with renal calculi B. A 23-year-old woman brought into the emergency department in hypovolemic shock C. A 32-year-old African American man admitted with anemia D. A 54-year-old Caucasian American man admitted with benign prostatic hypertrophy

C. A 32-year-old African American man admitted with anemia - Risk of CKD is increased in African American patients, regardless of socioeconomic status or age. - Benign prostatic hypertrophy, renal calculi, and hypovolemic shock are all causes of acute kidney injury (AKI).

Which laboratory test result should the nurse monitor as the principal marker of renal damage? A. Hematuria B. Pyuria C. Albuminuria D. Dysuria

C. Albuminuria - Albuminuria is considered the principal marker of renal damage. - Hematuria can indicate renal calculi or renal cancer but is not the principle marker for renal damage. - Dysuria is painful urination. - Pyuria is pus in the urine.

The nurse is reviewing laboratory results of a patient with acute kidney injury (AKI). For which finding should the nurse notify the healthcare provider? A. Urine glucose negative B. Serum potassium 4.1 mEq/L C. Estimated glomerular filtration rate of 59 mL/min/1.73 m2 D. Serum creatinine 3.2 mg/dL

C. Estimated glomerular filtration rate of 59 mL/min/1.73 m2 - An estimated GFR of 59 mL/min/1.73 m2 is considered diminished, a finding consistent with chronic kidney disease (CKD). - A negative urine glucose is a normal finding. - A serum creatinine concentration of 3.2 mg/dL is expected in kidney disease. - A serum potassium level of 4.1 mEq/L is a normal finding.

A patient is in the early stages of chronic kidney disease (CKD). For which risk factor should the nurse assess this patient? A. Benign prostatic hypertrophy B. Hemorrhage C. Hypertension D. Myocardial infarction

C. Hypertension - Hypertension is a risk factor for CKD. - Hemorrhage, myocardial infarction, and benign prostatic hypertrophy are risk factors for acute kidney injury.

The nurse is caring for a patient with metabolic acidosis. Which information should the nurse use when explaining the cause of metabolic acidosis as a result of chronic kidney disease (CKD)? A. There is a release of renin. B. The kidney decreases the secretion of erythropoietin. C. The kidney retains hydrogen ions as a result of a lack of functioning nephrons. D. There is an increase in blood urea nitrogen.

C. The kidney retains hydrogen ions as a result of a lack of functioning nephrons. - As the number of functioning nephrons decreases in chronic kidney disease (CKD), ammonia is excreted to maintain acid-base balance. The ammonia excreted falls with the glomerular filtration rate (GFR), causing the retention of hydrogen ions. This ultimately leads to the development of metabolic acidosis. - The reduced secretion of erythropoietin causes anemia. - The release of renin increases vasoconstriction and sodium retention. - Increased blood urea nitrogen (BUN) increases nitrogenous waste.

An older patient is scheduled for contrast radiography in the morning. Which factors should the nurse identify that may increase the risk for acute kidney injury (AKI) in this patient? A. Genetic disorders, ethnicity, and heart disease B. Obesity, autoimmune disorders, and GI disorders C. Environmental triggers, blood disorders, and use of thyroid medications D. Diabetes, hypertension, and use of nonsteroidal anti-inflammatory drugs

D. Diabetes, hypertension, and use of nonsteroidal anti-inflammatory drugs - The older adult's risk is increased when there is a history of nonsteroidal anti-inflammatory drug (NSAID) use, diabetes, heart disease, and hypertension. - Hypertension, heart disease, and obesity increase the patient's risk for CKD. - Environmental factors, thyroid medications, genetics, ethnicity, and autoimmune disorders are not risk factors for AKI or for older adults.

The nurse is identifying patients with nonmodifiable risk factors for chronic kidney disease (CKD) to participate in a clinical trial. Which risk factors should the nurse identify for this study? A. Hypertension, diabetes, and dehydration B. Crush injuries, nephrotoxins, and sickle cell disease C. Renal calculi, malignancy, and prostatic hypertrophy D. Genetics, polycystic kidney disease, and age

D. Genetics, polycystic kidney disease, and age - Common nonmodifiable risk factors for CKD include genetics, polycystic kidney disease, and age. - Hypertension, diabetes, and dehydration are all modifiable risk factors. - The other conditions listed are all causes of acute renal failure. - A polycystic kidney. The functional tissue of the kidneys is gradually destroyed and replaced with fluid-filled cysts.

The nurse is teaching a class about chronic kidney disease (CKD). Which should the nurse include? A. "Ethnicity and genetics are not causes of increased risk for CKD." B. "Hypertension is not related to CKD." C. "Diabetes mellitus and heart disease can cause CKD, and it always requires dialysis." D. "CKD may occur and progress faster to end-stage renal disease in African Americans."

D. "CKD may occur and progress faster to end-stage renal disease in African Americans." - African Americans are at a higher risk for CKD, regardless of socioeconomic status, and progress more quickly to end-stage renal disease (ESRD) than the general population. - Ethnicity and genetics do contribute to increased risk for ESRD. - Diabetes, heart disease, and hypertension are all risk factors but are not primary causes of ESRD or CKD and dialysis.

The nurse is teaching a class about acute kidney injury (AKI). Which statement by a participant should indicate that the teaching has been effective? A. "Prerenal AKI can result from benign prostatic hypertrophy." B. "Prerenal AKI can result from acute glomerulonephritis." C. "Prerenal acute kidney injury can result from nephrotoxic exposure." D. "Prerenal AKI can result from dehydration."

D. "Prerenal AKI can result from dehydration." - Dehydration contributes to prerenal acute kidney injury by reducing urine output. - Acute glomerulonephritis and nephrotoxic exposure are causes of intrinsic acute kidney injury. - Benign prostatic hypertrophy is a cause of postrenal acute kidney injury.

A patient with acute kidney injury (AKI) asks, "What is causing this swelling?" Which response should the nurse make? A. "The swelling is caused by enhanced erythropoietin secretion." B. "The swelling is caused by improved potassium excretion." C. "The swelling is caused by accelerated water depletion." D. "The swelling is caused by increased sodium retention."

D. "The swelling is caused by increased sodium retention." - Increased sodium retention causes water retention, which causes edema. - Water depletion causes dehydration, not edema. - Edema can cause hyperkalemia, not excretion of potassium. - Erythropoietin secretion does not increase the incidence of edema.

The nurse is planning to teach a patient with newly diagnosed chronic kidney disease (CKD). Which information about anemia and CKD should the nurse include? A. Decreased erythropoietin can increase the risk of sickle cell disease. B. The decreased release of renin contributes to the development of anemia. C. Thrombocytopenia occurs as a result of an increase of erythropoietin. D. Anemia is common because of decreased production of erythropoietin.

D. Anemia is common because of decreased production of erythropoietin. - Anemia is caused by decreased production of erythropoietin. - Renin is not associated with the development of anemia. - Thrombocytopenia does not occur due to the increased release of erythropoietin. - Sickle cell disease is a genetic disorder, which causes sickling of the red blood cells.

A patient at risk for chronic kidney disease has elevated levels of calcium and sodium. Which nursing intervention should the nurse perform? A. Administering epinephrine if blood pressure reaches 180/100 mmHg B. Repeating laboratory tests in 24 hours C. Checking cortisol every 6 hours D. Checking blood pressure every 2 hours

D. Checking blood pressure every 2 hours - The renin-angiotensin-aldosterone cascade stimulates sodium and water retention, causing increases in both sodium and calcium that result in vasoconstriction and increased blood pressure. - Cortisol causes an increase in blood glucose for energy expenditure and is not relevant. - Epinephrine is a part of the fight-or-flight response and would not be administered unless there was a cardiac event. - Repeated laboratory tests may be necessary, but this is outside of the nurse's scope of practice.