E3: Renal
Which findings may be present in the patient with significant fluid volume overload? (Select all that apply.) a. S3 or S4 may develop. b. Distention of the hand veins will disappear if the hand is elevated. c. When testing the quality of skin turgor, the skin will not return to the normal position for several seconds. d. Tachycardia with hypotension may be present. e. Dependent edema may be present.
ANS: A, E A gallop and dependent edema are indicative of fluid excess; the other signs are indicative of fluid volume deficit
A patient with chronic kidney disease was admitted with severe electrolyte disturbances. The patient had been ill and missed several hemodialysis sessions. The patient is disoriented, dizzy, cold, clammy, and complains of severe abdominal cramping. The patient's electrocardiogram appears normal. Which electrolyte disturbance would the nurse suspect the patient may be experiencing? a. Hyponatremia b. Hypokalemia c. Hypercalcemia d. Hypochloremia
A. Hyponatremia Hyperkalemia, hypocalcemia, hyponatremia, hyperphosphatemia, and acid-base imbalances occur in kidney disease. Signs of hyponatremia include disorientation, muscle twitching, nausea, vomiting, abdominal cramps, headaches, dizziness, cold, clammy skin, tachycardia, and seizures.
Loss of albumin from the vascular space may result in which condition? a. Peripheral edema b. Extra heart sounds c. Hypertension d. Hyponatremia
ANS: A Decreased albumin levels in the vascular space result in a plasma-to-interstitium fluid shift, creating peripheral edema. A decreased albumin level can occur as a result of protein-calorie malnutrition, which occurs in many critically ill patients in whom available stores of albumin are depleted. A decrease in the plasma oncotic pressure results, and fluid shifts from the vascular space to the interstitial space.
Which statement regarding kidney function and aging is accurate? a. Kidney function declines with age but this usually does not affect homeostasis. b. Serum creatinine rises with age due to increased catabolism of red muscle. c. Glomerular filtration rate falls at a rate of 2 mL/min/year. d. Older adults are less susceptible to acute kidney dysfunction but more susceptible to chronic kidney dysfunction.
ANS: A Kidney function declines gradually with age, but this usually does not affect homeostasis in the healthy older adult unless proteinuria is present. Proteinuria is associated with complication in both the kidney and cardiovascular systems. However, despite the gradual decrease in the glomerular filtration rate (GFR) and the associated reduction in clearance of creatinine, serum creatinine levels may not rise. With aging, the GFR declines by about 0.75 mL/min/year. When older adults become ill, the decline in kidney function can be accelerated, making older adults especially susceptible to acute and chronic kidney dysfunction.
A patient has been admitted with acute kidney injury. The nurse knows the most important consideration for evaluating the patient's fluid status is what parameter? a. Daily weights b. Urine and serum osmolality c. Intake and output d. Hemoglobin and hematocrit levels
ANS: A One of the most important assessments of kidney and fluid status is the patient's weight. In the critical care unit, weight is monitored for each patient every day and is an important vital signs measurement.
What substance is the most responsible for maintaining the colloid osmotic pressure? a. Intravascular plasma proteins b. Intracellular potassium c. Extracellular sodium d. Interstitial potassium
ANS: A Osmotic pressure is created by solutes and other substances (eg, albumin, globulin, fibrinogen) suspended in fluid. Colloid osmotic pressure is created primarily by the presence of plasma proteins in the intravascular space. Plasma proteins exert a pull on water molecules and therefore produce osmotic pressure, which retains fluid within the intravascular compartment.
Where does the concentration and dilution of urine occur? a. In the juxtamedullary nephrons b. In the cortical nephrons c. In the peritubular capillaries d. In the internal nephron
ANS: A The juxtamedullary nephrons have long loops of Henle that have an important role in the concentration and dilution of urine. The peritubular capillaries, known as the vasa recta, surround the juxtamedullary nephrons, maintaining a concentration gradient to concentrate the urine. Most nephrons are cortical nephrons. Both types of cortical nephrons perform excretory and regulatory functions.
A patient is admitted with severe hypokalemia. On admission the patient's laboratory values are serum K , 2.2 mEq/L; blood urea nitrogen (BUN), 15 mg/dL; and creatinine, 1.2 mg/dL. Urine output is averaging 45 mL/h. The patient is given a total of 80 mEq of potassium over 4 hours. The potassium level is repeated and the result is K , 2.4 mEq/L. What other information would be beneficial at this time? a. Magnesium level b. Repeat creatinine level c. Calcium level d. Hemoglobin level
ANS: A The levels of other intracellular electrolytes, such as calcium and potassium, are affected by the level of magnesium. The most important functions of magnesium are ensuring the transport of sodium and potassium across the cell membrane and as a co-factor in many intracellular enzyme reactions. Depletion of magnesium liberates potassium to the extracellular fluid, which causes an increase in the excretion of potassium by the kidney and hypokalemia. If the patient has a low magnesium level, it could explain the lack of response to the potassium infusions. The other levels have little effect on serum potassium level or its response to infusions.
A patient is admitted with respiratory failure and is being mechanically ventilated. The nurse understands there is a significant association between acute kidney injury and respiratory failure. How does mechanical ventilation alter kidney function? (Select all that apply.) a. Decreases blood flow to the kidney b. Decreases glomerular filtration rate (GFR) c. Damages the kidney tubular endothelium d. Decreases urine output e. Hinders flow of urine from the kidneys
ANS: A, B, D Mechanical ventilation can alter kidney function. Positive-pressure ventilation reduces blood flow to the kidney, lowers the glomerular filtration rate (GFR), and decreases urine output. These effects are intensified with the addition of positive end-expiratory pressure (PEEP).
What causes the presence of myoglobin in urine? (Select all that apply.) a. Bleeding b. Traumatic damage to the skeletal muscle c. Asthmatic attack d. Rhabdomyolysis e. Cocaine abuse
ANS: A, B, D, E Although a few red blood cells (RBCs) in the urine are normal, discernibly bloody urine usually indicates bleeding within the urinary tract or kidney trauma. The presence of myoglobin can make the urine appear red. Microscopic examination of the urine fails to reveal RBCs, with myoglobin being present instead. Myoglobin in the urine may result from skeletal muscle damage (eg, traumatic crush injury) or rhabdomyolysis. Rhabdomyolysis may develop in patients admitted to a critical care unit for many reasons, including traumatic injury, cocaine abuse, status epilepticus, heat prostration, or collapse during intense physical exercise (eg, running a marathon race on a hot day).
What are the functions of the kidneys? (Select all that apply.) a. Formation of urine b. Blood pressure regulation c. Erythrocyte destruction d. Breakdown of prostaglandins e. Regulation of acid-base balance
ANS: A, B, E The kidneys are complex organs responsible for numerous functions and substances necessary to maintain homeostasis. The primary roles of the kidneys are to remove metabolic wastes, maintain fluid and electrolyte balance, and help achieve acid-base balance. Hormones produced by the kidneys have an important role in blood pressure control, red blood cell production, and bone metabolism. The kidneys are important in maintaining the intracellular and extracellular environment required by all cells to function effectively.
The nursing management plan for the patient with a urinary drainage catheter would include which interventions to prevent catheter-associated urinary tract infection (CAUTI)? (Select all that apply.) a. Insert urinary catheters using aseptic techniques. b. Change the urinary catheter daily. c. Review the need for the urinary catheter daily and remove promptly. d. Flush the urinary catheter q8 hours to maintain patency. e. Avoid unnecessary use of indwelling urinary catheters.
ANS: A, C, E The key components of catheter-associated urinary tract infection (CAUTI) prevention are to avoid unnecessary use of urinary catheters, insert urinary catheters using aseptic technique, adopt evidence-based standards for maintenance of urinary catheters, review the need for the urinary catheter daily, and remove the catheter promptly.
A patient has been on complete bed rest for 3 days. The practitioner has left orders to get the patient out of bed for meals. The patient complains of feeling dizzy and faint while sitting at the bedside. The nurse suspects that the patient is experiencing what problem? a. Orthostatic hypertension b. Orthostatic hypotension c. Hypervolemia d. Electrolyte imbalance
ANS: B Orthostatic hypotension produces subjective feelings of weakness, dizziness, or faintness. Orthostatic hypotension occurs with hypovolemia or prolonged bed rest or as a side effect of medications that affect blood volume or blood pressure.
A patient has been admitted in acute heart failure. Which parameter would indicate to the nurse that the patient is fluid overloaded? a. Central venous pressure of 4 mm Hg b. Pulmonary artery occlusion pressure (PAOP) of 18 mm Hg c. Cardiac index of 2.5 L/min/m2 d. Mean arterial pressure of 40 mm Hg
ANS: B The pulmonary artery occlusion pressure (PAOP) represents the left atrial pressure required to fill the left ventricle. When the left ventricle is full at the end of diastole, this represents the volume of blood available for ejection. It is also known as left ventricular preload and is measured by the PAOP. The normal PAOP is 5 to 12 mm Hg. In fluid volume excess, PAOP rises. In fluid volume deficit, PAOP is low.
The following substances, among others, are found in a patient's urine sample: urea, creatinine, sodium, chlorine, potassium, glucose, and bicarbonate ions. Which patient situation could account for this abnormal finding? a. Blood pressure of 76/30 mm Hg b. Blood glucose of 456 mg/dL c. Blood glucose of 40 mg/dL d. Blood potassium level of 4.1 mEq/L
ANS: B This glucose reading is above the threshold concentration. Glucose is normally completely reabsorbed from the tubules. Above the threshold level, the tubules are unable to reabsorb all of the glucose, and some spills into the urine. All of the other findings in this urine sample are normal findings.
A patient was admitted with acute heart failure who has been receiving diuretic therapy. The nurse suspects the patient is hypovolemic. What auscultatory parameter would confirm the nurse's suspicion? a. Hypertension b. Third or fourth heart sound c. Orthostatic hypotension d. Vascular bruit
ANS: C A drop in systolic blood pressure of 20 mm Hg or more, a drop in diastolic blood pressure of 10 mm Hg or more, or a rise in pulse rate of more than 15 beats/min from lying to sitting or from sitting to standing indicates orthostatic hypotension. The drop in blood pressure occurs because a sufficient preload is not immediately available when the patient changes position. The heart rate increases in an attempt to maintain cardiac output and circulation.
Which type of intravenous fluid will not create a shift of fluids within the vascular space? a. Hypertonic b. Hypotonic c. Isotonic d. Osmotic pressure
ANS: C An isotonic solution has roughly the same concentration of particles as the blood plasma; cells within an isotonic solution maintain consistency and do not lose or gain fluid to their surroundings. A hypertonic solution contains a greater concentration of particles than that inside the cell and causes fluid to be drawn out of the cells. Used inappropriately, too much fluid may be withdrawn, causing a withering of the cell (crenation). A hypotonic solution contains a lesser concentration of particles than that inside the cell and causes fluid to be drawn into the cells. If used incorrectly, a hypotonic solution can cause too much fluid to enter the cell, causing the cells to swell and burst (hemolysis). Osmotic pressure is created by solutes and other substances (eg, albumin, globulin, fibrinogen) suspended in fluid.
What is the functional unit of the kidney called? a. Bowman capsule b. Glomerulus c. Nephron d. Distal tubule
ANS: C Each kidney is made up of about 1 million nephrons, the functional units of the kidneys. Each nephron is made up of several distinct structures, which are the glomerulus, Bowman capsule, proximal tubule, loop of Henle, distal tubule, and collecting duct.
A patient is admitted in acute heart failure secondary to renal insufficiency. The patient reports that over the past few weeks, his urine output has decreased, and he has developed peripheral edema and ascites. The nurse suspects the main cause of ascites is what condition? a. Hypervolemia b. Dehydration c. Volume overload d. Liver damage
ANS: C Individuals with kidney failure may have ascites caused by volume overload, which forces fluid into the abdomen because of increased capillary hydrostatic pressures. However, ascites may or may not represent fluid volume excess. Severe ascites in persons with compromised liver function may result from decreased plasma proteins. The ascites occurs because the increased vascular pressure associated with liver dysfunction forces fluid and plasma proteins from the vascular space into the interstitial space and abdominal cavity. Although the individual may exhibit marked edema, the intravascular space is volume depleted, and the patient is hypovolemic.
The initial filtering of the blood occurs in which structure? a. The distal tubule b. The proximal tubule c. The glomerulus d. The collecting tubule
ANS: C The first structure of each nephron is the glomerulus, a high-pressure capillary bed that serves as the filtering point for the blood. Positive filtration pressure in the glomerulus is achieved as a result of the high arterial pressure as the blood enters the afferent arteriole and the resistance created by the smaller efferent arteriole as the blood exits the glomerulus. As a result of the positive-pressure gradient, fluid and solutes are filtered through the glomerular capillary walls.
A patient has been admitted with acute kidney injury. Which serum laboratory values would the nurse expect to be ordered to confirm this diagnosis? a. Sodium and potassium b. Creatinine and calcium c. Blood urea nitrogen (BUN) and creatine d. Potassium and magnesium
ANS: C Urea and creatinine are the primary waste products that are measured in determining kidney function. Urea is measured as blood urea nitrogen and is the end product of protein metabolism and results from the breakdown of ammonia in the liver. Like urea, creatinine accumulates when the glomerulus is unable to filter it from the blood.
A patient was admitted with multiple trauma who has been volume resuscitated. The nurse suspects the patient is fluid overloaded. Which assessment findings would confirm the nurse's suspicion? a. Venous filling of the hand veins greater than 5 seconds b. Distended neck veins in the supine position c. Presence of orthostatic hypotension d. Presence of a third heart sound
ANS: D Auscultation of the heart requires not only assessing rate and rhythm but also listening for extra sounds. Fluid overload is often accompanied by a third or fourth heart sound, which is best heard with the bell of the stethoscope.
A patient has been admitted with acute kidney injury. Which parameter would the nurse expect to find to confirm this diagnosis? a. Decreased blood urea nitrogen b. Bibasilar lung crackles c. Peripheral edema d. Decreased creatinine clearance
ANS: D Creatinine is used as a measure of the glomerular filtration rate (GFR) because it is a waste product produced at a fairly constant rate by the muscles, is freely filtered by the glomerulus, and is minimally resorbed or secreted by the tubules. Therefore, most of the creatinine produced by the body is excreted by the kidneys, making the creatinine clearance a good screening and follow-up test for estimating the GFR. A creatinine clearance less than 100 mL/min reflects a GFR of less than 100 mL/min and is a signal of decreased kidney function. A creatinine clearance (and GFR) less than 20 mL/min results in symptoms of kidney failure.
A patient has been admitted with a severe kidney infection. The nurse suspects the patient has damage to the glomerular membrane. Which substance in the urine would confirm the nurse's suspicion? a. Creatinine b. Bicarbonate ions c. Sodium d. Albumin
ANS: D Large molecules such as albumin and red blood cells are prevented from entering the filtrate. The presence of large molecules in the urine is a signal that the glomerular membrane is damaged or affected by disease.
Which electrolyte abnormality is evident early in the course of kidney failure? a. Sodium b. Potassium c. Chloride d. Phosphorus
ANS: D Phosphorus abnormalities are evident early in the course of kidney failure.
A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms. The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia. The nurse suspects the patient may be experiencing what condition? a. Dehydration b. Peritonitis c. Fluid obstruction d. Hernias
a. Dehydration This patient has dehydration. This patient is showing signs and symptoms of muscle cramps and low blood pressure.
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse knows the hemodialyzer filter used in this type of therapy is permeable to what substance? a. Electrolytes b. Red blood cells c. Protein d. Lipids
a. Electrolytes A continuous venovenous hemodialysis filter is permeable to solutes such as urea, creatinine, uric acid, sodium, potassium, ionized calcium, and drugs not bound by proteins.
The practitioner has ordered dialysis for a patient with acute heart failure who is unresponsive to diuretics. Which type of dialysis would the nurse anticipate being started on this patient? a. Intermittent ultrafiltration b. Continuous venovenous hemofiltration (CVVH) c. Continuous venovenous hemodialysis (CVVHD) d. Continuous venovenous hemodiafiltration (CVVHDF)
a. Intermittent ultrafiltration Intermittent ultrafiltration using a peripheral venous catheter is more likely to be used to remove excess volume from patients with acute decompensated heart failure when the kidneys are unresponsive to diuretics.
A patient is admitted with acute kidney injury (AKI). Which event from the patient's history was the most probable cause of the patient's AKI? a. Recent computed tomography of the brain with and without contrast b. Recent bout of acute heart failure after an acute myocardial infarction c. Twice-daily prescription of Lasix 40 mg by mouth d. Recent bout of benign prostatic hypertrophy and transurethral resection of the prostate
a. Recent computed tomography of the brain with and without contrast Intravenous contrast media can be nephrotoxic, especially with the patient's preexisting cardiac disease. The other choices, although possible causes, are less likely than the intravenous contrast media.
A patient with acute kidney injury has a potassium level of 6.9 mg/dL. The patient has had no urine output in the past 4 hours despite administration of Lasix 40 mg intravenous push. To correct the hyperkalemia the patient is given 50 mL of 50% dextrose in water and 10 U of regular insulin intravenous push. A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL. What order would the nurse expect now? a. Sodium Kayexalate 15 g PO b. Nothing; this represents a normal potassium level c. Lasix 40 mg IVP d. 0.9% normal saline at 125 mL/h
a. Sodium Kayexalate 15 g PO Acute hyperkalemia can be treated temporarily by intravenous (IV) administration of insulin and glucose. An infusion of 50 mL of 50% dextrose accompanied by 10 units of regular insulin forces potassium out of the serum and into the cells. However, the potassium was not eliminated from the body; it was simply shifted intracellularly. Soon the potassium will return to the bloodstream, and the Kayexalate will help permanently remove it from the body. Lasix is not expected to work in the presence of anuria. The patient's vital signs do not support hypovolemia. In the presence of anuria, a large fluid infusion can precipitate acute heart failure.
To remove fluid during hemodialysis, a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath. What is this process called? a. Ultrafiltration b. Hemodialysis c. Reverse osmosis d. Colloid extraction
a. Ultrafiltration To remove fluid, a positive hydrostatic pressure is applied to the blood, and a negative hydrostatic pressure is applied to the dialysate bath. The two forces together, called transmembrane pressure, pull and squeeze the excess fluid from the blood. The difference between the two values (expressed in millimeters of mercury [mm Hg]) represents the transmembrane pressure and results in fluid extraction, known as ultrafiltration, from the vascular space.
The practitioner has ordered continuous renal replacement therapy (CRRT) for a patient with acute kidney injury. The patient needs both the removal of fluids and a moderate amount of solutes. Which type of CRRT would the nurse anticipate being started on this patient? a. Slow continuous ultrafiltration (SCUF) b. Continuous venovenous hemofiltration (CVVH) c. Continuous venovenous hemodialysis (CVVHD) d. Continuous venovenous hemodiafiltration (CVVHDF)
b. Continuous venovenous hemofiltration (CVVH) Continuous venovenous hemofiltration (CVVH) is indicated when the patient's clinical condition warrants removal of significant volumes of fluid and solutes. Fluid is removed by ultrafiltration in volumes of 5 to 20 mL/min or up to 7 to 30 L/24 h. Removal of solutes such as urea, creatinine, and other small non-protein-bound toxins is accomplished by convection
A patient was admitted with an infection that had to be treated with an aminoglycoside antibiotic. After a few days the patient developed oliguria and elevated blood urea nitrogen and creatinine levels. The patient's vital signs are stable. The nurse would anticipate the practitioner ordering which dialysis method for this patient? a. Peritoneal dialysis b. Hemodialysis c. Continuous renal replacement therapy d. Intermittent ultrafiltration
b. Hemodialysis As a treatment, hemodialysis separates and removes from the blood excess electrolytes, fluids, and toxins by means of a hemodialyzer. Hemodialysis would be the first choice for managing this patient with medication toxicity.
A patient was admitted with an infection that had to be treated with gentamicin, an aminoglycoside antibiotic. After 3 days of administration, the patient developed oliguria, and an elevated blood urea nitrogen and creatinine levels. The nurse suspects the patient has developed what type of kidney injury? a. Prerenal b. Intrarenal c. Anuric d. Postrenal
b. Intrarenal Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of intrarenal. Ischemic damage may be caused by prolonged hypotension or low cardiac output. Toxic injury reaction may occur in response to substances that damage the kidney tubular endothelium, such as some antimicrobial medications and the contrast dye used in radiologic diagnostic studies.
A patient has developed acute kidney injury (AKI) secondary to hemorrhage shock. Which intravenous solution would the nurse expect to be ordered for this patient? a. Dextrose in water b. Normal saline c. Albumin d. Lactated Ringer solution
b. Normal saline Prerenal acute kidney injury (AKI) is caused by decreased perfusion and flow to the kidney. It is often associated with trauma, hemorrhage, hypotension, and major fluid losses. If contrast dye is used, aggressive fluid resuscitation with normal saline is recommended.
A patient has developed acute kidney injury (AKI) secondary to cardiogenic shock. Which laboratory value would the nurse find helpful in evaluating patient's renal status? a. Serum sodium b. Serum creatinine c. Serum potassium d. Urine potassium
b. Serum creatinine Serum creatinine is the most reliable predictor of kidney function. In the acutely ill patient, small changes in the serum creatinine level and urine output may signal important declines in the glomerular filtration rate and kidney function.
What is the most common site for short-term vascular access for immediate hemodialysis? a. Subclavian artery b. Subclavian vein c. Femoral artery d. Radial vein
b. Subclavian vein Subclavian and femoral veins are catheterized when short-term access is required or when a graft or fistula vascular access is nonfunctional in a patient requiring immediate hemodialysis. Subclavian and femoral catheters are routinely inserted at the bedside. Most temporary catheters are venous lines only. Blood flows out toward the dialyzer and flows back to the patient through the same catheterized vein. A dual-lumen venous catheter is most commonly used.
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodiafiltration (CVVHDF). The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy? a. Hypervolemia, hypothermia, and hyperkalemia b. Access dislodgment, decreased outflow pressures, and bleeding c. Filter clotting, access failure, and air embolism d. Increased overflow pressure, dehydration, and calcium loss
c. Filter clotting, access failure, and air embolism Circuit-related complications of continuous renal replacement therapy include air embolism, clotted hemofilter, poor ultrafiltration, blood leaks, broken filter, disconnection, access failure, and catheter dislodgement
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands the patient should be closely monitored for what patient-related complications of the therapy? a. Air embolism, access failure, and blood leaks b. Decreased inflow pressure, air bubbles, and power surge c. Infection, hypotension, and electrolyte imbalances d. Catheter dislodgement, decreased outflow pressure, and acid-base imbalances
c. Infection, hypotension, and electrolyte imbalances Patient-related complications of continuous renal replacement therapy (CRRT) include dehydration, hypotension, electrolyte imbalances, acid-base imbalances, blood loss, hemorrhage, hypotension, and infection.
A patient with chronic kidney disease receives hemodialysis treatments 3 days a week. Every 2 weeks, the patient requires a transfusion of 1 or 2 U of packed red blood cells. What is the probable reason for this patient's frequent transfusion needs? a. Too much blood phlebotomized for tests b. Increased destruction of red blood cells because of the increased toxin levels c. Lack of production of erythropoietin to stimulate red blood cell formation d. Hemodilution secondary to fluid retention
c. Lack of production of erythropoietin to stimulate red blood cell formation In chronic kidney disease, the kidneys do not produce sufficient amounts of erythropoietin in response to normal stimuli such as anemia or hypotension. The other choices are not reasons for frequent blood transfusions in this patient.
A patient was admitted with liver failure and acute kidney injury (AKI). Which intravenous solution should the nurse question if it were ordered for this patient? a. D5W b. 0.9% NaCl c. Lactated Ringer solution d. 0.45% NaCl
c. Lactated Ringer solution Lactated Ringer solution is contraindicated for patients with kidney or liver diseases or in lactic acidosis.
To assess whether or not an arteriovenous fistula is functioning, what must the nurse do and why? a. Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. b. Palpate the quality of the pulse proximal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow. c. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow. d. Palpate over the site of the fistula to determine whether a thrill is present; check whether the extremity is pink and warm.
c. Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow. The nurse frequently assesses the quality of blood flow through the fistula. A patent fistula has a thrill when palpated gently with the fingers and a bruit when auscultated with a stethoscope. The extremity should be pink and warm to the touch. No blood pressure measurements, intravenous infusions, or laboratory phlebotomy is performed on the arm with the fistula.
An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage. The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)? a. Intrinsic b. Postrenal c. Prerenal d. Intrarenal
c. Prerenal Any condition that decreases blood flow, blood pressure, or kidney perfusion before arterial blood reaches the renal artery that supplies the kidney may be anatomically described as prerenal acute kidney injury (AKI). When arterial hypoperfusion caused by low cardiac output, hemorrhage, vasodilation, thrombosis, or other cause reduces the blood flow to the kidney, glomerular filtration decreases, and consequently urine output decreases. Any condition that produces an ischemic or toxic insult directly at parenchymal nephron tissue places the patient at risk for development of intrarenal AKI. Any obstruction that hinders the flow of urine from beyond the kidney through the remainder of the urinary tract may lead to postrenal AKI.
One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin. Which statement regarding how this treatment works is accurate? a. Glucose and insulin force potassium out of the cells, lowering it on a cellular level. b. Glucose and insulin promote higher excretion of potassium in the urine. c. Glucose and insulin bind with potassium, lowering available amounts. d. Glucose and insulin force potassium into the cells, lowering it on a serum level.
d. Glucose and insulin force potassium into the cells, lowering it on a serum level. Acute hyperkalemia can be treated temporarily by intravenous administration of insulin and glucose. An infusion of 50 mL of 50% dextrose accompanied by 10 units of regular insulin forces potassium out of the serum and into the cells.
Laboratory results come back on a newly admitted patient: Serum blood urea nitrogen, 64 mg/dL; serum creatinine, 2.4 mg/dL; urine osmolality, 210 mOsm/kg; specific gravity, 1.002; and urine sodium, 96 mEq/L. The patient's urine output has been 120 mL since admission 2 hours ago. These values are most consistent with which diagnosis? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Oliguric acute kidney injury d. Intrarenal acute kidney injury
d. Intrarenal acute kidney injury Urinary sodium less than 10 mEq/L (low) suggests a prerenal condition. Urinary sodium greater than 40 mEq/L (in the presence of an elevated serum creatinine and the absence of a high salt load) suggests intrarenal damage has occurred. The urine output does not seem to suggest oliguria. The other options do not fit the data as presented.
A patient with acute kidney injury (AKI) has been started on continuous venovenous hemodialysis (CVVHD). The nurse understands that this type of continuous renal replacement therapy (CRRT) is indicated for the patient who needs what type of treatment? a. Fluid removal only b. Fluid removal and moderate solute removal c. Fluid removal and maximum solute removal d. Maximum fluid and solute removal
d. Maximum fluid and solute removal Continuous venovenous hemodialysis (CVVHD) is indicated for patients who require large-volume removal of fluid and solutes.
A patient is admitted with sepsis and acute kidney injury (AKI). The patient is started on continuous renal replacement therapy (CRRT). The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet? a. Convection b. Diffusion c. Replacement fluid d. Ultrafiltrate
d. Ultrafiltrate The fluid that is removed each hour is not called urine; it is known as ultrafiltrate. Typically, some of the ultrafiltrate is replaced through the continuous renal replacement therapy circuit by a sterile replacement fluid. Diffusion is the movement of solutes along a concentration gradient from a high concentration to a low concentration across a semipermeable membrane. Convection occurs when a pressure gradient is set up so that the water is pushed or pumped across the dialysis filter and carries the solutes from the bloodstream with it.
