Chapter 16: Acute Kidney Injury

The patient is in the critical care unit and will receive dialysis this morning. The nurse will take which actions: (Select all that apply.) A. Evaluate morning laboratory results and report abnormal results. B. Administer the patient's antihypertensive medications. C. Assess the dialysis access site and report abnormalities. D. Weigh the patient to monitor fluid status. E. Give all medications except for antihypertensive medications.

A. Evaluate morning laboratory results and report abnormal results. C. Assess the dialysis access site and report abnormalities. D. Weigh the patient to monitor fluid status.

Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.) A. Hypotension B. Dysrhythmias C. Muscle cramps D. Hemolysis E. Air embolism

A. Hypotension B. Dysrhythmias

The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier with a blood pressure of 80/44 mm Hg and heart rate of 122 beats/min. The patient reports having not voided in 8 hours but there is no distention of the bladder. The nurse anticipates what "stat" order? A. A blood transfusion B. Fluid replacement with 0.45% saline C. Infusion of an inotropic agent D. An antiemetic

B. Fluid replacement with 0.45% saline

Daily weights are being recorded for a patient with urine output that has been less than intravenous and oral intake. The patient's weight yesterday was 97.5 kg and this morning it is 99 kg. The nurse understands that this corresponds to what? a. A fluid retention of 1.5 liters. b. A fluid loss of 1.5 liters. c. An equal intake and output due to insensible losses. d. A fluid loss of 0.5 liters.

a. A fluid retention of 1.5 liters.

The patient receiving hemodialysis 3 days a week is 74 inches tall and weighs 100 kg. In planning the care for this patient, the nurse provides what nutritional recommendation? a. Intaking 2500 to 3500 kcal diet per day b. Limiting protein intake to less than 50 grams per day c. Encouraging potassium intake of 10 mEq per day d. Limiting fluid intake of less than 500 mL per day

a. Intaking 2500 to 3500 kcal diet per day

The patient's potassium level is 7.0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction? a. Kayexalate b. Kayexalate with sorbitol c. Regular insulin d. Calcium gluconate

a. Kayexalate

Noninvasive diagnostic procedures used to determine kidney function include which of the following? (Select all that apply.) a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI) d. Intravenous pyelography (IVP) e. Renal angiography

a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI)

What is the most common cause of acute kidney injury (AKI) in critically ill patients? a. Sepsis b. Fluid overload c. Medications d. Hemodynamic instability

a. Sepsis

What is a normal glomerular filtration rate? a. Less than 80 mL/min b. 80 to 125 mL/min c. 125 to 180 mL/min d. More than 189 mL/min

b. 80 to 125 mL/min

What term is used to describe an increase in blood urea nitrogen (BUN) and serum creatinine? a. Oliguria b. Azotemia c. Acute kidney injury d. Prerenal disease

b. Azotemia

The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. What action should the nurse take? a. Prepare to assist with a routine dialysis catheter change to replace the existing catheter. b. Evaluate the patient for signs and symptoms of infection. c. Teach the patient that the catheter is designed for long-term use. d. Use one of the three lumens for fluid administration.

b. Evaluate the patient for signs and symptoms of infection.

With sudden cessation of renal function, all body systems are affected by the inability to maintain fluid and electrolyte balance and eliminate metabolic waste. In critically ill patients, what statement regarding renal dysfunction is true? a. It is a very rare problem. b. It affects nearly two thirds of patients. c. It has a low mortality once renal replacement therapy has been initiated. d. It has little effect on morbidity, mortality, or quality of life.

b. It affects nearly two thirds of patients.

The patient reporting severe flank pain when urinating. has a urinalysis that shows sediment and crystals along with a few bacteria. This information suggestions what about the nature of the condition? a. It is prerenal. b. It is postrenal. c. It is intrarenal. d. It is not renal related

b. It is postrenal.

How is peritoneal dialysis different from hemodialysis? a. It is more frequently used for acute kidney injury. b. It uses the patient's own semipermeable membrane (peritoneal membrane). c. It is not useful in cases of drug overdose or electrolyte imbalance. d. It is not indicated in cases of water intoxication.

b. It uses the patient's own semipermeable membrane (peritoneal membrane).

The patient has just returned from having an arteriovenous fistula placed. The patient asks, "When will they be able to use this and take this other catheter out?" The nurse should provide what response? a. "It can be used immediately so the catheter can come out anytime." b. "It will take 2 to 4 weeks to heal before it can be used." c. "The fistula will be usable in about 4 to 6 weeks." d. "The fistula was made using graft material so it depends on the manufacturer."

c. "The fistula will be usable in about 4 to 6 weeks."

Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. What is the most common intrarenal condition that produces such a kidney injury? a. Prolonged ischemia. b. Exposure to nephrotoxic substances. c. Acute tubular necrosis (ATN). d. Hypotension for several hours.

c. Acute tubular necrosis (ATN).

The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place. In caring for this patient, the nurse should take what action? a. Apply a sterile gauze dressing to maintain sterility. b. Replace the transparent dressing every 10 days to prevent manipulation. c. Assess the catheter site for redness and/or swelling. d. Use the catheter for drawing blood samples to reduce patient discomfort.

c. Assess the catheter site for redness and/or swelling.

The patient is on intake and output (I&O) as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should take what action? a. Draw a trough level after the next dose of antibiotic. b. Obtain an order to place the patient on fluid restriction. c. Assess the patient's lungs. d. Insert an indwelling catheter.

c. Assess the patient's lungs.

What is a normal urine output? a. 80 to 125 mL/min b. 180 L/day c. 80 mL/min d. 1 to 2 L/day

d. 1 to 2 L/day

The patient in progressive care unit following arteriovenous fistula implantation in the left upper arm, is due to have blood drawn with the next set of vital signs and assessment. When the nurse assesses the patient, the nurse should take what action? a. Draw blood from the left arm. b. Take blood pressures from the left arm. c. Start a new intravenous line in the left lower arm. d. Auscultate the left arm for a bruit and palpate for a thrill.

d. Auscultate the left arm for a bruit and palpate for a thrill.

The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patient's urinalysis results. What related assessment finding should concern the nurse? a. Creatinine levels in the urine are similar to blood levels of creatinine. b. Sodium and chloride are found in the urine. c. Urine uric acid levels have the same values as serum levels. d. Red blood cells and albumin are found in the urine.

d. Red blood cells and albumin are found in the urine.

The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.) a. Acidosis b. Hypokalemia c. Volume overload d. Hyperkalemia e. Uremia

a. Acidosis c. Volume overload d. Hyperkalemia e. Uremia

Renin plays a role in blood pressure regulation by what process? a. Activation of the renin-angiotensin-aldosterone cascade. b. Suppression of angiotensin production. c. Decreasing of sodium reabsorption. d. Inhibition of aldosterone release.

a. Activation of the renin-angiotensin-aldosterone cascade.

The nurse is caring for a patient receiving peritoneal dialysis. The patient suddenly reports experiencing abdominal pain and chills. The patient's temperature is elevated. The nurse should take what action? a. Assess peritoneal dialysate return. b. Check the patient's blood sugar. c. Evaluate the patient's neurological status. d. Inform the provider of probable visceral perforation.

a. Assess peritoneal dialysate return.

The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, what should the nurse do? a. Assess that the blood tubing is warm to the touch. b. Assess the hemofilter every 6 hours for clotting. c. Cover the dialysis lines to protect them from light. d.Use clean technique during vascular access dressing changes.

a. Assess that the blood tubing is warm to the touch.

The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include what intervention? (Select all that apply.) a. Bladder catheterization b. Increasing fluid volume intake c. Ureteral stenting d. Placement of nephrostomy tubes e. Increasing cardiac output

a. Bladder catheterization c. Ureteral stenting d. Placement of nephrostomy tubes

The nurse caring for a patient who has undergone major abdominal surgery notices that the patient's urine output has been less than 20 mL/hour for the past 2 hours. At 0200 in the morning the patient's blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should take what action? a. Contact the primary health care provider and expect an order for a normal saline bolus. b. Wait until 0900 when the provider makes rounds to report the assessment findings. c. Continue to evaluate urine output for 2 more hours. d. Ignore the urine output, as this is most likely postrenal in origin.

a. Contact the primary health care provider and expect an order for a normal saline bolus.

What event triggers acute kidney injury from post renal etiology? a. Obstruction of the flow of urine. b. Conditions that interfere with renal perfusion. c. Hypovolemia or decreased cardiac output. d. Conditions that act directly on functioning kidney tissue.

a. Obstruction of the flow of urine.

Continuous venovenous hemofiltration is used for what purpose? a. Remove fluids and solutes through the process of convection. b. Remove plasma water in cases of volume overload. c. Remove plasma water and solutes by adding dialysate. d. Combine ultrafiltration, convection and dialysis.

a. Remove fluids and solutes through the process of convection.

Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used for what purpose? a. Remove plasma water in cases of volume overload. b. Remove fluids and solutes through the process of convection. c. Remove plasma water and solutes by adding dialysate. d. Combine ultrafiltration, convection and dialysis.

a. Remove plasma water in cases of volume overload.

The patient is a new postoperative patient. She weighs 75 kg. The nurse expects the minimal acceptable urine output to be what? a. Less than 30 mL/hour. b. 37 mL/hour. c. 80 mL/hour. d. 150 mL/hour.

b. 37 mL/hour.

The nurse caring for an elderly patient who was admitted with renal insufficiency realizes that with advance age often comes declining renal function. What is an expected laboratory finding for this patient? a. An increased glomerular filtration rate (GFR) b. A normal serum creatinine level c. Lower serum levels of prescribed medications d. Hypokalemia

b. A normal serum creatinine level

The patient has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. What do these levels most likely indicate? a. Increased nitrogen intake b. Acute kidney injury, such as acute tubular necrosis (ATN) c. Hypovolemia d. Fluid resuscitation

b. Acute kidney injury, such as acute tubular necrosis (ATN)

The patient diagnosed with acute kidney injury and has been getting dialysis 3 days per week reports general malaise and is tachypneic. An arterial blood gas is ordered and shows that the patient's pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to take what action? a. Administer morphine to slow the respiratory rate. b. Prepare for intubation and mechanical ventilation. c. Administer intravenous sodium bicarbonate. d. Cancel tomorrow's dialysis session.

c. Administer intravenous sodium bicarbonate.

The nurse assessing a patient with a new arteriovenous fistula, does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should take what action? a. Reassess the patient in an hour. b. Raise the arm above the level of the patient's heart. c. Notify the primary health care provider immediately. d. Apply warm packs to the fistula site and reassess.

c. Notify the primary health care provider immediately.

Which of the following patients is at the greatest risk of developing acute kidney injury? a. One who had a diagnostic test using a radiocontrast media 6 days. b. One with a history of controlled hypertension with a blood pressure of 138/88 mm Hg. c. One discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks. d. One with a history of fluid overload as a result of heart failure.

c. One discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks.

Continuous venovenous hemodialysis is used for what purpose? a. Remove fluids and solutes through the process of convection. b. Remove plasma water in cases of volume overload. c. Remove plasma water and solutes by adding dialysate. d. Combine ultrafiltration, convection and dialysis

c. Remove plasma water and solutes by adding dialysate.

What is an advantage of peritoneal dialysis? a. Peritoneal dialysis is time intensive. b. It has a decreased risk of peritonitis. c. Any biochemical disturbances are corrected rapidly. d. The danger of hemorrhage is minimal.

d. The danger of hemorrhage is minimal.

How does continuous renal replacement therapy (CRRT) differ from conventional intermittent hemodialysis? a. A hemofilter is used to facilitate ultrafiltration. b. It provides faster removal of solute and water. c. It does not allow diffusion to occur. d. The process removes solutes and water slowly.

d. The process removes solutes and water slowly.

The removal of plasma water and some low-molecular weight particles by using a pressure or osmotic gradient is identified by what term? a. Dialysis b. Diffusion c. Clearance d. Ultrafiltration

d. Ultrafiltration

The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for what intervention? a. Insertion of a percutaneous catheter at the bedside. b. Insertion a percutaneous tunneled catheter at the bedside. c. Creation of an arteriovenous fistula. d. Creation of an arteriovenous graft.

a. Insertion of a percutaneous catheter at the bedside.

Presence of which substances would indicate a problem with renal function. (Select all that apply.) a. Protein b. Sodium c. Creatinine d. Red blood cells e. Uric acid

a. Protein d. Red blood cells e. Uric acid

The patient getting hemodialysis for the second time reports a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of what possible complication? a. Dialyzer membrane incompatibility b. A shift in potassium levels c. Dialysis disequilibrium syndrome d. Hypothermia

c. Dialysis disequilibrium syndrome

The patient's serum creatinine level is 0.7 mg/dL. The expected BUN level should be a. 1 to 2 mg/dL. b. 7 to 14 mg/dL. c. 10 to 20 mg/dL. d. 20 to 30 mg/dL.

b. 7 to 14 mg/dL.