A
Which option is a prerenal cause of AKI?
A) Aminoglycoside usage
B) Decreased cardiac output
C) Foley catheter obstruction
D) Acute tubular necrosis
B) Decreased cardiac output
Decreased cardiac output is a prerenal cause of AKI. Aminogylcosides are kidney toxic, representing an intrarenal cause of AKI, acute tubular necrosis also is an intrarenal cause of AKI. Foley catheter obstruction is a post renal cause of AKI.
A patient with hepatitis is extremely confused, has altered speech. The patient is doagnosed with hepatic encephalopathy. What lab result would correlate with the mental status changes?
A) Bilirubin 6
B) BUN 22
C) Ammonia 85
D) Lactic acid 0
C) Ammonia 85
Normal ammonia levels are 15-45, so 85 is high and would correlate to the mental changes observed in the client.
Which complication does the nurse expect in a patient who has multiple myeloma?
A) Syndrome of inappropriate anti diuretic hormone
B) Hypercalcemia
C) Superior Vena cava syndrome
D) Amnesia
B) Hypercalcemia
Multiple myeloma cancer secrets parathyroid hormone and releases calcium from the bones, resulting in hypercalcemia. Lorazepam treatment can cause amnesia. Superior vena cava syndrome causes compression of the superior vena cava. Gastrointestinal cancers stimulates the posterior pituitary gland to secrete anti diuretic hormone and causes the SIADH.
A patient with acute pancreatitis reports blurred vision and has consumed 2000 mL in the past 4 hours. What is the nurse's priority action?
A) Notify provider
B) Ensure an IV is present and patent
C) Notify the provider
D) Check the patient's blood sugar
D) Check the patient's blood sugar
The patient is demonstrating signs of hyperglycemia. Considering that with acute pancreatitis, insulin production can be impaired if the islet cells are affected, and blood sugar can increase in response to stress, making hyperglycemia likely. Based on the polydipsia and blurred vision, the nurse should follow up by checking the blood sugar.
A patient is to receive hemodialysis treatment at 1600, it is currently 0800, and the patient has a scheduled dose of labetalol due now, and a scheduled dose of morphine at 1000. What should the nurse do?
A) Hold both medications
B) Give the morphine at the scheduled time, but hold the labetalol
C) Contact the dialysis nurse before giving any medications
D) Give both medications
C) Contact the dialysis nurse before giving any medications
Administration of antihypertensive drugs should be withheld 4-6 hours prior to dialysis. Given the timeframe, it is likely to be approved to be given. Consult the dialysis nurse or pharmacist to determine which meds to withhold or administer. While it is before the hold range for the labetalol, contacting the dialysis nurse to know which meds are okay to give is appropriate. Doses of other medications which lower blood pressure (such as sedatives, narcotics) should be reduced.
Which clinical finding in a patient indicates ulcerative colitis?
A) Inflammation of the ileum and colon
B) Thickened bowel wall
C) Bowel fistulas
D) Presence of blood and mucus in the stool
D) Presence of blood and mucus in the stool
Presence of blood and mucus in the stool is caused by bleeding in the intestinal mucosa. This symptom is indicative of ulcerative colitis. Strictures and deep ulcerations occur in Crohn's disease, which put the patient at risk for developing bowel fistulas. Thickened bowel walls and inflammation of ileum and colon are seen in Crohn's disease.
Which interventions would be implemented for a patient with acute kidney injury caused by decreased fluid volume? (SATA)
A) Dopamine
B) Removal of urinary catheter
C) Daily weights
D) High protein diet
E) Fluid therapy
A, C, and E
Dopamine will increase blood pressure and renal perfusion, addressing the original problem of fluid volume deficit in addition to fluid therapy. Daily weights and I/Os will help to gather baseline data and evaluate effectiveness of other interventions. Catheter insertion may be necessary for I/Os, but catheter removal would be utilized for post renal causes of AKI. Low protein diet may be utilized as AKI can cause protein catabolism (breakdown).
Select all options that are manifestations of acute kidney injury from intrarenal cause. (SATA)
A) Hypotension
B) Oliguria
C) Disorientation
D) Hypoventilation
E) Decreased BUN
B & C.
Intrarenal AKI is demonstrated HTN with oliguria. Other signs are weight gain, edema, distended neck veins, hyperventilation in response to metabolic acidosis, dry mucous membranes, crackles, uremia (fatigue, drowsiness, disorientation, malaise), hyperpyrexia. Prerenal causes would be manifested as hypotension, tachycardia.
The patient with liver failure demonstrates difficulty breathing and a respiratory rate of 25 breathes per minute. The student nurse is correct when they state...
A) Liver failure causes respiratory infection from the pathogen hepatitis A virus.
B) Fluid can accumulate in the peritoneum, making it difficult for the diaphragm to contract.
C) Given the proximity of the the liver to the lungs, damage to the liver is likely to damage the lungs as well.
D) Given that protein breakdown creates ammonia, and ammonia buildup causes hepatic encephalopathy, the patient is likely demonstrating a key sign of hepatic encephalopathy.
B) Fluid can accumulate in the peritoneum, making it difficult for the diaphragm to contract.
Ascites occurs from impaired handling of salt and water by the kidneys, leading to fluid accumulation in the peritoneum. Put the patient in semi-fowlers, monitor rr rate, pulse ox, breath sounds, and abdominal girth.
The nurse is providing care for a newly admitted client diagnosed with hepatic failure. Which intervention should the nurse perform while providing care for the client? (SATA)
A) Give stool softeners
B) Take glucometer readings every 12 to 24 hours
C) Measure the abdominal girth
D) Monitor BUN, LFT’s, PT/PTT levels
E) Encourage a high protein diet
A) Give stool softeners, C) Measure the abdominal girth, D) Monitor BUN, LFT’s, PT/PTT levels
Measuring the abdominal girth will reveal if fluid is accumulating. Stool softeners can decrease the ammonia build up, which lowers the risk of hepatic encephalopathy. Clot synthesis is decreased, so monitoring pt/ptt levels in necessary. Glucometer readings should be more frequent than q12-24h given that altered carbohydrate metabolism is characteristic of hepatitis. Hyperglycemia and glucagon induced hypoglycemia can occur. Protein is already elevated from liver failure, so adding high protein is not advised.
A patient's GFR reads as 26mL/min. What would this number be categorized as?
A) Stage 3 Moderate
B) Stage 2 Mild
C) Stage 5 ESRD
D) Stage 4 Severe
D) Stage 4 Severe
GFR of 15-29mL/min are Stage 4 Severe. <15 would be End Stage Renal Disease. 30-59 is moderate, 60-89 is mild, and >90 is stage 1 risk.
A patient with hepatitis wants to know what dietary and GI interventions are advised for treatment. Select all options which are true. (SATA)
A) Patient will eat a keto diet
B) Patient will have to avoid alcohol
C) A Sangstaken-Blakemore tube will need to be placed
D) Antiemetics to help nausea and vomiting can be administered
E) Small frequent meals are given
B) Patient will have to avoid alcohol, D) Antiemetics to help nausea and vomiting can be administered, E) Small frequent meals are given
High carb, high calorie diet with moderate fats and proteins are given in small frequent meals. Avoid alcohol, stay hydrated. A keto diet is about 70-75% fat, 15-20% protein, and 5-10% carbohydrates. Asking about food preferences is also important. The Sangstaken-Blakemore tube is for esophageal varices hemorrhaging.
Which intervention is NOT associated with acute pancreatitis treatment?
A) Seizure precautions
B) Clear liquid diet
C) Pain control with PCA pump
D) Fluid administration
B) Clear liquid diet
Nasogastric secretions and NPO status are used to prevent secretin from being secreted. Fluid administration may be necessary as fluid third spaces, leading to hypovolemia. Fluids will help perfuse the pancreas and kidneys. Lactated ringers or colloids may be administered. Hypocalcemia can occur, which leaves the patient vulnerable to seizures, cardiac dysrhythmias. Having respiratory support equipment, seizure precautions in place, and ECG tracing in place may be necessary. Pain control should be mandatory rather than prn, assess pain with appropriate scale. Pain can increase the patient's metabolism, which would increase the pancreatic secretions.
Select the electrolyte imbalance(s) associated with acute kidney injury. (SATA)
A) Hypokalemia
B) Hyperphosphatemia
C) Hypermagnesemia
D) Hypernatremia
E) Hypocalcemia
B, C, and E are correct.
With acute kidney injury, it is possible to see hyperkalemia, hyponatremia, hypocalcemia, hyperphosphatemia, and hypermagnesemia.
Select all that are potential systemic complications of acute pancreatitis.
A) Hypovolemic shock
B) Neuroleptic Malignant Syndrome
C) Syndrome of Inappropriate Antidiuretic Hormone
D) Acute Respiratory Distress Syndrome (ARDS)
E) Coagulation Defects
A) Hypovolemic shock, D) Acute Respiratory Distress Syndrome (ARDS), E) Coagulation Defects
Hypovolemic shock can potentially occur, warranting close monitoring of fluid status and fluid management, but not so much as to cause fluid overload. ARDS, arterial hypoxemia, atelectasis, pneumonia can occur, so deep breathing, coughing, and frequent position changes should be practiced. Coagulation defects are similar to DIC.
A patient undergoing continuous renal replacement therapy can no longer receive heparin after having platelets drop to 35,000 and petechia evident during assessment. What does the nurse anticipate using instead of heparin for this patient?
A) Warfarin
B) Enoxaparin
C) Alteplase
D) Citrate
D) Citrate
Citrate chelates calcium in the serum and inhibits activation of the coagulation cascade. Systemic anticoagulation is minimal because the liver quickly converts citrate to bicarbonate. You should monitor calcium levels if using citrate.
The patient is admitted for GI bleeding, but the source is unknown. Before ordering endoscopy, the provider orders octreotide to be given intravenously. The purpose of this medication is to...
A) Increase blood flow in the liver’s collateral circulation
B) Vasodilate the splanchnic arteriolar bed.
C) Decrease splanchnic blood flow and portal pressure
D) Increase portal pressure and improve liver function
C) Decrease splanchnic blood flow and portal pressure
Octreotide is commonly ordered to slow or stop bleeding. Early administration provides for stabilization before endoscopy. These drugs decrease splanchnic blood flow, reduce portal pressure, and have minimal adverse effects. Octreotide does not increase portal pressure, vasodilate the splanchnic arterial bed, or increase blood flow in the liver's collateral circulation.
The nursing student is assigned to care for a client with a diagnosis of Acute kidney injury, diuretic phase. The nursing instructor asked the student about the primary goal of the treatment plan for this client, which goal, if stated by the nursing student, indicates an adequate understanding of the treatment plan for this client?
A) Promote the excretion of wastes
B) Prevents loss of electrolytes
C) Reduce the urine specific gravity
D) Prevent fluid overload
B) Prevents loss of electrolytes
In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on fluid and electrolyte replacement and monitoring.
The nurse instructor is evaluating a nurse student for knowledge regarding care of a client with acute kidney injury. Which statement by the student demonstrates the need for further teaching about the diuretic phase of acute kidney injury?
A) The increase in urine output indicates the return of some renal function.
B) The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.
C) The diuretic phase is characterized by an increase in urine output, about 500ML in a 24 hour.
D) The blood urea, nitrogen and creatinine levels will continue to rise during the first few days of diuresis.
C) The diuretic phase is characterized by an increase in urine output, about 500ML in a 24 hour.
The diuretic phase of acute kidney injury is characterized by an increase in urine output of more than 1000ML in a 24 hour. This increase in urine output indicates the return of some renal function. However, blood urea, nitrogen and creatinine levels continue to rise during the first few days of diuresis. The diuretic phase develops about 14 days after the initial insult and lasts about 10 days.
The patient with hepatic encephalopathy is prescribed Lactulose. What is the purpose of lactulose in the treatment of hepatic encephalopathy?
A) Increase mental status from confused, lethargic state
B) Lower hepatic enzyme levels; decreases liver inflammation
C) Decrease muscle breakdown
D) Decrease platelet aggregation, preventing stroke
A) Increase mental status from confused, lethargic state
Lactulose creates an acidic environment in the bowel that causes the ammonia to leave the bloodstream and enter the colon, where it becomes trapped until the laxative effect of lactulose causes it to be excreted in bowel. Lactulose is given orally or in a rectal enema.
A nurse finishes educating the patient about management of chronic kidney disease. Which statement made by the patient indicates a need for further teaching?
A) Meds such as kayexalate, calcium gluconate, insulin/dextrose may be used to lower potassium levels
B) Epoetin alfa may be used to treat anemia
C) I must report to my provider if I gain 2 or more lbs in a week
D) I need to avoid foods such as potatoes, apricots, bananas, oranges
C) I must report to my provider if I gain 2 or more lbs in a week
The patient with CKD should report gains of >2 lbs in a day or >5 lbs in a week. Lower potassium is a goal of treatment, so A is appropriate. Anemia is a common complication of CKD, so B is also appropriate, and the foods listed in D are high in potassium, so they must be avoided.
The patient's morning lab reveals the patient with AKI has a potassium level of 6.4 mEq/L. What is the nurse's PRIORITY intervention?
A) Insert an NG tube
B) Acquire kayexalate
C) Attach cardiac leads
D) Document the findings
C) Attach cardiac leads
The priority is to attach cardiac leads to assess abnormal heart rhythms. Kayexalate/Polystyrene sulfonate may be used to lower serum potassium levels, but the potential for abnormal rhythms takes priority.
A new nurse is ordered to a creatinine clearance test on a patient. The new nurse asks the experienced nurse how to perform the creatinine clearance test. Arrange the steps of the creatinine clearance test in order.
1. Serum creat level assessed at end of 24 hrs
2. All urine for next 24 hrs saved in container and stored in fridge
3. Collection is sent to the lab for testing
4. Bladder emptied, exact time recorded, urine discarded
5. Exactly 24 hrs after start of procedure pt voids again, specimen saved
4, 2, 5, 1, 3.
A creatinine clearance test compares the amount of creatinine in the blood to the amount in the urine over a 24-hour period. This shows how fast the kidneys clear creatinine from the body. A doctor may ask you to do a creatinine clearance test to see how well the kidneys are working.
A 54 year old male patient with a 10 year hx of smoking, 9 year hx of diabetes mellitus, GFR of 9mL/L, surgical hx from 24 years ago for acute appendicitis is admitted with end stage renal disease, and inquires as to whether they would be eligible for a renal transplant. How should the nurse respond?
A) You are a good candidate because your GFR is 9mL/L
B) You would not be eligible because of your 9 year Hx of diabetes mellitus
C) You would not be eligible because of your 10 year Hx of smoking
D) You are a good candidate because your last surgical procedure was 24 years ago and only included your appendix
C) You would not be eligible because of your 10 year Hx of smoking
Morbidly obese and smokers are not candidates for renal transplants. Indications for renal transplant for patients with ESRD are GFR <15 mL/L, HTN, DM, polycystic disease, metabolic disorders, autoimmune disorders, and chronic renal failure. A patient cannot have disseminated malignancies, refractory cardiac diseases, chronic resporatory failure, extensive vascular disease, chronic infection, or unresolved psych disorders.
A client with chronic kidney disease being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious, and the nurse suspects air embolism. What are the priority nursing actions? (SATA)
A) Continue dialysis at a slower rate after checking the lines for air
B) Stop dialysis and turn the client on the left side with head lower than feet
C) Bolus the client with 500ML of normal saline to break up the air embolus
D) Administer oxygen to the client
E) Notify the Primary Health care provider and rapid response team
D) Administer oxygen to the client, E) Notify the Primary Health care provider and rapid response team
If the client experiences air embolus during hemodialysis, the nurse should terminate dialysis immediately, position the client so the embolus is in the right side of the heart, notify the PHCP and rapid response team, and administer oxygen as needed. Slowing the dialysis treatment or giving an intravenous bolus will not correct the air embolism or prevent complications.