Acute Kidney Injury (AKI)
A nurse is caring for a client experiencing acute kidney injury caused by severe dehydration and hypovolemia. Which classification of AKI does this represent?
Prerenal acute kidney injury because the cause occurs before the kidney and results from decreased renal perfusion such as hypovolemia, shock, or blood loss
A nurse is educating a client about the most common cause of chronic renal failure. Which condition should the nurse identify?
Diabetes mellitus because chronic hyperglycemia damages renal blood vessels and is the leading cause of progressive kidney failure.
A nurse is reviewing laboratory results for a client with possible renal impairment. Which laboratory value is considered the most reliable indicator of kidney function?
Serum creatinine because it reflects skeletal muscle waste that is filtered by the kidneys and is less affected by diet or protein breakdown than BUN, making it a more accurate indicator of renal function.
A nurse is caring for a client with renal failure who develops hyperkalemia. Which medication helps remove potassium from the body through sodium exchange?
Sodium polystyrene sulfonate because it exchanges sodium for potassium in the gastrointestinal tract and removes potassium through stool.
A nurse is reviewing a client’s laboratory results and preparing for dialysis initiation. At what eGFR level is dialysis generally started?
Dialysis is typically initiated when eGFR drops below 10–15 mL/min because kidney filtration is no longer sufficient to maintain metabolic balance.
A nurse is caring for a client who developed AKI after receiving nephrotoxic medications. Which classification of AKI is this?
Intrarenal acute kidney injury because the damage occurs inside the kidney due to toxins, infections, or structural kidney disorders.
A nurse assesses a client with chronic kidney disease who reports fatigue and weakness. Which complication explains this finding?
Anemia due to decreased erythropoietin production because damaged kidneys cannot stimulate red blood cell formation.
A nurse reviews a client’s laboratory results and notes a BUN level of 28 mg/dL. Which interpretation should the nurse make?
BUN above the normal range of 10–20 mg/dL indicates decreased kidney filtration or increased protein breakdown, suggesting impaired glomerular filtration.
A nurse administers IV glucose and insulin to a client with severe hyperkalemia. What is the purpose of this intervention?
Insulin drives potassium into the cells while glucose prevents hypoglycemia, temporarily lowering serum potassium levels.
A nurse assesses the vascular access of a client receiving hemodialysis. Which finding indicates that an AV fistula is functioning properly?
Presence of a palpable thrill and an audible bruit indicating blood is flowing through the fistula.
A nurse assesses a client with kidney stones causing urinary obstruction and decreased urine flow. Which classification of AKI is most likely?
Postrenal acute kidney injury because the obstruction occurs after urine leaves the kidney and blocks normal urinary flow.
A nurse observes a client with chronic renal failure breathing deeply and rapidly. Which condition explains this respiratory pattern?
Kussmaul respirations resulting from severe metabolic acidosis as the body attempts to compensate by eliminating excess carbon dioxide.
A nurse is determining the most accurate test for measuring glomerular filtration rate. Which diagnostic test provides the best measurement?
Creatinine clearance obtained through a 24-hour urine collection because it directly measures the kidneys’ ability to filter creatinine from the blood.
A nurse is caring for a client with renal failure who develops hypocalcemia. Which pathophysiologic process causes this imbalance?
The kidneys cannot activate vitamin D, which is required for calcium absorption from the gastrointestinal tract.
A nurse notes headache, nausea, and disorientation in a client receiving hemodialysis. Which complication should the nurse suspect?
Dialysis disequilibrium syndrome caused by rapid removal of urea leading to cerebral edema.
A nurse is monitoring a client during the oliguric phase of AKI. Which laboratory abnormalities should the nurse expect?
Elevated potassium, phosphorus, and creatinine because decreased urine production causes retention of electrolytes and metabolic waste
A nurse notes a white crystalline substance on the skin of a client with advanced renal failure. Which condition does this indicate?
Uremic frost caused by crystallized urea deposits on the skin due to extremely elevated blood urea levels.
A nurse is reviewing urinalysis findings for a client with suspected kidney disease. Which finding is considered an early indicator of chronic kidney disease?
Persistent protein in the urine because protein leakage indicates early glomerular damage before major decreases in kidney function occur.
Question:
A nurse is providing dietary teaching for a client with chronic kidney disease. Which diet is recommended?
High carbohydrate and low protein diet because protein metabolism produces nitrogenous waste that damaged kidneys cannot adequately filter.
A nurse observes cloudy drainage from a peritoneal dialysis catheter. Which complication does this finding indicate?
Peritonitis because infection of the peritoneal cavity typically presents first with cloudy dialysate and abdominal pain.
A nurse observes that a client recovering from AKI is producing 4,000 mL of urine in 24 hours. Which phase of AKI is occurring?
Diuretic phase because kidney function begins improving and large volumes of urine are produced, placing the client at risk for electrolyte imbalances such as hypokalemia and hyponatremia.
A nurse is educating a client about symptoms of chronic kidney disease. When do symptoms typically begin to appear?
When approximately 75 percent of kidney function is lost because early disease is often asymptomatic until significant nephron damage occurs.
A nurse reviews laboratory findings and notes a glomerular filtration rate of 30 mL/min. How should the nurse interpret this result?
Significantly reduced kidney filtration because normal GFR in healthy adults is approximately 120–130 mL/min, indicating substantial loss of renal function.
A nurse monitors a client with kidney failure for hypoglycemia. Why are these clients at higher risk?
Impaired renal gluconeogenesis and prolonged circulation of insulin cause decreased blood glucose levels.
A client receiving hemodialysis suddenly develops chest pain and dyspnea during treatment. Which complication should the nurse suspect and what is the immediate action?
Air embolism requiring immediate clamping of the venous line, stopping the dialysis pump, and positioning the client on the left side with the head down to trap air in the right atrium.