AKI
A patient has been diagnosed with prerenal acute renal failure. What condition most likely caused this situation?
A) Toxic levels of medications
B) Poststreptococcal glomerulonephritis
C) Severe sepsis and shock
D) Benign prostatic hypertrophy
C) Severe sepsis and shock
A patient with chronic renal failure also has chronic anemia, arteriosclerotic disease, and diabetes mellitus. The patient asks the nurse why the anemia is persisting. In answering the patients question, what should the nurse most consider?
A) The patient most likely has preexisting chronic anemia.
B) Erythropoietin is primarily produced in the kidney.
C) The patient is receiving low-dose aspirin therapy.
D) Chronic renal failure results in persistent uremia.
B) Erythropoietin is primarily produced in the kidney.
A patient with acute kidney injury (AKI) complains of a headache. He vomits several times and breathes deeply and rapidly. His heart rate is 110 bpm, and his serum potassium level is elevated. The nurse recognizes in this patient which condition commonly associated with AKI?
A) Fluid overload B) Anemia C) Metabolic acidosis
D) Pericarditis
C) Metabolic acidosis
The patient requires urgent hemodialysis or continuous renal replacement therapy after a suicide attempt with a variety of antidepressants. What access route for the dialysis does the nurse anticipate?
A) Vascular catheter B) Arteriovenous fistula C)Synthetic vascular graft D) Peritoneal dialysis catheter
A) Vascular catheter
The nurse is caring for a patient with renal disease and is monitoring fluid balance. What is the most accurate method for assessing fluid balance?
A) Daily weights at same time of day
B) Episodic intake and output totals
C) Heart rate trends
D) Jugular venous volume measurement
A) Daily weights at same time of day
A patient has had an arteriovenous fistula placed for access for long-term hemodialysis. What nursing assessment result indicates a patent and functional fistula?
A) Diminished intensity of palpated fistula thrill
B) Clearly auscultated bruit over fistula
C) Ability to draw blood from proximal vessel
D) Full range of motion of joints below fistula
B) Clearly auscultated bruit over fistula
An elderly male patient in the ICU is diagnosed with acute kidney injury. This patient demonstrates a decreased glomerular filtration rate and lowered urine sodium concentration, as well as increased BUN and serum creatinine levels. The nurse observes that the patient takes several minutes to empty his bladder when he uses the bathroom. His blood pressure and blood glucose levels are normal. What should the nurse suspect as the cause of this patients acute kidney injury?
A) Tubular necrosis as a result of accumulation of radiocontrast dye in the renal tubular cells B)Obstruction of the flow of urine due to benign prostatic hypertrophy C) Lack of perfusion due to congestive heart failure D) Hypotension due to systemic inflammatory response to sepsis
B) Obstruction of the flow of urine due to benign prostatic hypertrophy
The nurse is teaching a patient with chronic renal failure and diabetes mellitus about nutrition. What should be included?
A) Calorie restriction based on ideal body weight is necessary. B) Sodium and potassium should be supplemented while on dialysis. C) Renal diet restrictions take the place of those for diabetes mellitus. D) Moderate protein restriction is recommended while otherwise healthy.
D) Moderate protein restriction is recommended while otherwise healthy.
A patient in oliguric renal failure is receiving IV furosemide (Lasix). What nursing assessment has the highest priority?
A) Daily weights B) Intake and output C) Serum potassium D) Blood urea nitrogen
C) Serum potassium
A patient in the ICU with severe hypotension is experiencing acute renal failure and uremia and needs dialysis. She requires a large infusion of intravenous fluids regularly. The nurse recognizes that which method of dialysis would be best for this patient?
A) Continuous venovenous hemofiltration (CVVH)
B) Continuous venovenous hemofiltration with dialysis (CVVH/D)
C) Intermittent hemodialysis
D) Peritoneal dialysis
B) Continuous venovenous hemofiltration with dialysis (CVVH/D)
A patient's lab results include a finding of glucose in the urine (glycosuria). What other lab result should the nurse expect in this patient?
A) Decreased ketones in the urine
B) Alkaline urinary pH
C) Elevated blood glucose
D) Decreased urine volume
C) Elevated blood glucose
The patient is scheduled to receive hemodialysis for 4 hours this morning, and several medications for chronic diseases are scheduled to be given now. All of the medications will be at least partially removed by dialysis. What is the best nursing action?
A) Give all medications as scheduled.
B) Give double doses of all medications.
C) Withhold medications for today only.
D) Administer medications after dialysis.
D) Administer medications after dialysis.
During physical examination of an ambulatory patient, the nurse finds elevated blood pressure, pulmonary crackles that do not clear with cough, jugular venous distention, liver congestion and enlargement, an S3 heart sound, and pitting edema of the feet and lower legs. What is the most likely cause of this group of findings?
A) Fluid volume deficit B) Fluid volume excess
C) Hyponatremia D) Leukocytosis
B) Fluid volume excess
A patient is concerned about her steadily worsening chronic kidney disease and asks the nurse at what point she will require dialysis or renal transplantation. Which of the following should the nurse mention?
A) When your urine albumin-to-creatinine ratio is greater than 25 mg/g
B) When your urine output is less than 0.5 mL/kg/h 6 h
C) When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2
D) When your urine osmolality is greater than 500 mOsm/kg H2O
C) When your glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m2
A patient has significantly decreased creatinine clearance and an elevated serum creatinine. What does this value indicate to the nurse?
A) Improved renal function
B) Kidney damage from disease
C) Muscle wasting
D) Rhabdomyolysis
B) Kidney damage from disease
The nurse is explaining the underlying principles of dialysis to a patient who is starting peritoneal dialysis for the management of chronic renal failure. As part of the teaching, what physiologic process does the nurse explain produces the most waste product removal?
A) Water molecule movement by osmosis
B) Diffusion to a less concentrated area
C) Active transport by an energy-driven process
D) Increased osmotic gradient from the abdomen
B) Diffusion to a less concentrated area
On auscultating the patient's heart, the nurse hears a third heart sound. What condition would this finding be most indicative of?
A) Renal artery stenosis
B) A faulty stethoscope
C) Hypotension
D) Fluid overload
D) Fluid overload
An elderly patient in the ICU with chronic renal failure has just undergone surgery for a synthetic arteriovenous graft in her left forearm for dialysis access. The nurse recognizes that the most likely reason this patient received a graft instead of a fistula is which of the following?
A) Thrombosis is less likely to occur with grafts than with fistulas.
B) Fistulas are more prone to infection than are grafts.
C) The patient's own blood vessels were not adequate for fistula formation.
D) An aneurysm is more likely to occur in a fistula than in a graft.
C) The patient's own blood vessels were not adequate for fistula formation.
A patient with acute kidney injury (AKI) demonstrates blue mottling of the skin in her fingers. What other finding would tend to indicate that the cause of this condition is intrarenal?
A) Distended bladder B) Edema C) Strep throat infection D) Kinked Foley catheter
C) Strep Throat Infection
A patient with chronic renal disease is involved in a motor vehicle crash and experiences severe hypovolemia. In caring for this patient in the CCU, which of the following is the most important for the nurse to monitor?
A) Blood pressure B) Fluid volume recovery C) Urine output D) Cardiac dysrhythmias
B) Fluid Volume Recovery
In a patient with acute ischemic tubular necrosis, urine output has increased from below normal to very high. What is the nursing priority of care during this phase of renal failure?
A) Restrict fluid intake B) Monitor serum potassium C)De-emphasize dialysis D) Monitor serum creatinine
B) Monitor serum potassium
A patient in the ICU is scheduled to begin peritoneal dialysis for acute renal failure. The patient tells the nurse that he understands hemodialysis but is not familiar with peritoneal dialysis. He asks her what the difference between them is. The nurse explains that the biggest difference between these two approaches is which of the following?
A) Peritoneal dialysis relies on diffusion whereas hemodialysis relies on active transport.
B) The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis.
C) Hemodialysis uses a Tenckhoff catheter, whereas peritoneal dialysis uses a venous catheter.
D) Hemodialysis uses machines called cyclers to cycle the infusion and removal of blood, whereas peritoneal dialysis uses the body's own vascular system to do this.
B) The peritoneum of the body serves as the semipermeable membrane in peritoneal dialysis, whereas an extracorporeal semipermeable membrane is used in hemodialysis.
A patient with renal impairment is found to have a positive Chvostek's sign. What additional information should the nurse assess for?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypermagnesemia
C) Hypocalcemia
A patient in the ICU has acute renal failure and is an alcoholic. Which electrolyte imbalance would the nurse most expect to find in this patient?
A) Hypokalemia
B) Hyperkalemia
C) Hypermagnesemia
D) Hypomagnesemia
D) Hypomagnesemia
A patient with prerenal acute kidney injury is oliguric. The nurse is administering an IV bolus to the patient. What should be of primary concern to the nurse while performing this task?
A) Restricting the patients protein intake
B) Monitoring the patients potassium level
C) Evaluating the patient for signs of nephrotoxicity
D) Preventing fluid overload
D) Preventing fluid overload
A patient has been diagnosed with chronic renal failure. What closely associated pathophysiologies should the nurse assess for? Select all that apply.
A) Hypertension B) Arteriosclerotic disease C)Traumatic injury D) Type 2 diabetes mellitus
E) Preeclampsia F) Type 1 diabetes mellitus
A) Hypertension
B) Arteriosclerotic disease
D) Type 2 diabetes mellitus
F) Type 1 diabetes mellitus
What laboratory value is most likely to indicate renal failure?
A) Elevated blood urea nitrogen (BUN)
B) Low hemoglobin and hematocrit
C) Elevated serum creatinine
D) Normal urine osmolarity
C) Elevated serum creatinine
The patient is receiving continuous renal replacement therapy (CRRT). The rate of ultrafiltration shows a downward trend and coagulation of the filter is suspected. What is the most appropriate first nursing action?
A) Immediately disconnect circuit from the patient.
B) Decrease the rate of blood flow by pump.
C) Use a saline bolus to diagnosis clot location and extent.
D)Raise the ultrafiltration collection device.
C) Use a saline bolus to diagnosis clot location and extent.
The nurse is working with a patient with suspected acute renal failure. Which of the assessments would provide accurate information about this patient's fluid balance? Select all that apply.
A) Daily measure of patient's weight at the same time, using same scale
B) Monitoring of intake and output every 1 to 2 hours
C) Monitoring of blood sugar levels hourly
D) Taking x-rays of the kidneys weekly
A) Daily measure of patient's weight at the same time, using same scale
B) Monitoring of intake and output every 1 to 2 hours
A patient with chronic kidney disease is receiving an ACE inhibitor. The nurse understands that this medication helps slow the progression of this disease through what process?
A) It lowers the level of blood glucose.
B) It prevents nephron hyperfiltration.
C) It increases the urine output.
D) It filters waste from the blood.
B) It prevents nephron hyperfiltration.