CHAPTER 26: KIDNEY DISORDERS AND THERAPEUTIC MANAGEMENT {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 26: K IDNEY D ISORDERS AND
T HERAPEUTIC M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. 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 t ype of CRRT would
the nurse anticipate being started on this patient?
a. Slow continuous ultrafiltration (SCUF)
b. Continuous venovenous hemofiltration (CVVH)
c. Continuous venovenous hemodial ysis (CVVHD)
d. Continuous venovenous hemodiafiltration (CVVHDF)



ANS: B



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 m L/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.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 648 |
p. 649 | Table 27 -9 OBJ: Nursing Process Step:

, Intervention TOP: Renal MSC: NC LEX: Physiologic
Integrit y



2. A patient with acute kidney injury (AKI) has been started on c ontinuous
venovenous hemodialysis (CVVHD). The nurse understands the patient
should be closel y 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 electrol yte imbalances
d. Catheter dislodgement, decreased outflow pressure, and acid –base
imbalances



ANS: C



Patient-related complications of continuous renal replacement therapy
(CRRT) include dehydration, hypotension, ele ctrol yte imbalances,
acid–base imbalances, blood loss, hemorrhage, hypotension, and
infection.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 653 |
Box 26-9 OBJ: Nursing Process Step: Intervention
TOP: Renal MSC: NC LEX: Physiologic Integrit y



3. A patient with acute kidney injury (AKI) has been started on continuous
venovenous hemodialysis (CVVHD). The nurse understands that this t ype
of continuous renal replacement therapy (CRRT) is indicated for the
patient who needs what t ype of treatment?
a. Fluid remov al onl y
b. Fluid removal and moderate solute removal

, c. Fluid removal and maximum solute removal
d. Maximum fluid and solute removal



ANS: D



Continuous venovenous hemodial ysis (CVVHD) is indicated for
patients who require large -volume removal of fluid and solutes.



PTS: 1 DIF: Cognitive Level: Understanding REF: p.
648 | Table 26 -9 OBJ: Nursing Process Step: Intervention
TOP: Renal MSC: NC LEX: Physiologic Integrit y



4. A patient with acute kidney injury (AKI) has been started on continuous
venovenous hemodialysi s (CVVHD). The nurse knows the hemodial yzer
filter used in this t ype of therapy is permeable to what substance?
a. Electrol ytes
b. Red blood cells
c. Protein
d. Lipids



ANS: A



A continuous venovenous hemodial ysis filter is permeable to solutes
such as urea, creatinin e, uric acid, sodium, potassium, ionized calcium,
and drugs not bound by proteins.



PTS: 1 DIF: Cognitive Level: Remembering REF: p. 645
OBJ: Nursing Process Step: Intervention TOP:
Renal MSC: NC LEX: Physiologic Integrit y