Chapter 68 Care of Patients with Acute Kidney Injury and Chronic Kidney Disease

1. Which problems occur with AKI (SATA) a. Decreased peristalsis b. Anemia c. Metabolic acidosis d. Hypokalemia e. Peripheral edema - abce 2. The community health nurse is designing programs to reduce kidney problems and kidney injury among the general public. In order to do so, the nurse targets health promotion and compliance with therapy for people with which conditions? a. Diabetes mellitus and hypertension b. Frequent episodes of sexually transmitted disease c. Osteoporosis and other bone disease d. Gastroenteritis and poor eating habits - a 3. What are common causes of prerenal kidney injury? (SATA) a. Urethral cancer b. Hypovolemic shock c. Enlarged prostate gland d. Sepsis e. Severe burns - bde 4. A patient can develop intrarenal kidney injury from which causes? (SATA) a. Vasculitis b. Pyelonephritis c. Strenuous exercise d. Exposure to nephrotoxins e. Bladder cancer - abd 5. Postrenal kidney injury can result from which conditions? (SATA) a. Septic shock b. Cervical cancer c. Nephrolithiasis or ureterolithiasis d. Heart failure e. Neurogenic bladder f. Prostate cancer - bcef 6. When shock or other problems cause an acute reduction in blood flow to the kidneys, how do the kidneys compensate? (SATA) a. Constrict blood vessels in the kidneys b. Activate the renin-angiotensin-aldosterone pathway c. Release beta blockers d. Dilate blood vessels throughout the body e. Release antidiuretic hormones - abe 7. The nurse reads in the patient's chart that he has acute-on-chronic kidney disease. How does the nurse interpret this information? a. Kidney disease has progressed to the need for dialysis or transplant b. Patient has chronic kidney disease and has sustained an acute kidney injury c. Acute kidney injury requires aggressive management to prevent chorionic disease d. The condition could be acute or chronic; further diagnostic testing is needed - b 8. The nurse is talking to a group of healthy young college students about maintaining good kidney health and preventing AKI. Which health promotion point is the nurse most likely to emphasize this group? a. "Have your blood pressure checked regularly" b. "Find out if you have a family history of diabetes" c. "Avoid dehydration by drinking at least 2 to 3 L of water daily" d. "Have annual testing for microalbuminuria and urine protein" - c 9. The nurse is caring for a patient who had hypovolemic shock secondary to trauma in the ED 2 days ago. Based on the pathophysiology of hypovolemia and prerenal azotemia, what does the nurse assess at least every hour? a. Urinary output b. Presence of edema c. Urine color d. Presence of pain - a 10. The nurse is talking to an older adult male patient who is reasonably healthy for his age, but has BPH. Which condition does the BPH potentially place him at risk for? a. Prerenal acute kidney injury b. Postrenal acute kidney injury c. Polycystic kidney disease d. Acute glomerulonephritis - b 11. Which combination of drugs is the most nephrotoxic? a. ACE inhibitors and aspirin b. Angiotensin II receptor blockers and antacids c. Aminoglycoside antibiotics and NSAIDs d. Calcium channel blockers and antihistamines - c 12. The nurse is caring for several patients on a medical-surgical unit. None of the patients currently has any acute or chronic kidney problems. Which patient has the greatest risk to develop AKI? a. 73-year-old male who has hypertension and peripheral vascular disease b. 32-year-old female who is pregnant and has gestational diabetes c. 49-year-old male who is obese and has a history of skin cancer d. 23-year-old female who has been treated for a urinary tract infection - a 13. For a patient with AKI, the nurse would consider questioning the order for which diagnostic test? a. Kidney biopsy b. Ultrasonography c. Computed tomography with contrast dye d. Kidney, ureter, bladder (KUB) x-ray - c 14. The nurse is caring for a postoperative patient and is evaluating the patient's intake and output as a measure to prevent AKI. The patient weighs 60 kilograms and has produced 180 mL of urine in the past 4 hours. HWat should the nurse do? a. Perform other assessments related to fluid status and record the output b. Call the health care provider and obtain an order for a fluid bolus c. Encourage the patient to drink more fluid, so that the output is increased d. Compare the patient weight to baseline to determine fluid retention - a 15. The nurse is caring for a patient receiving gentamicin. Because this drug has potential for nephrotoxicity, which laboratory results does the nurse monitor? (SATA) a. BUN b. Creatinine c. Drug peak and trough levels d. PT e. Platelet count f. Hemoglobin and hematocrit - abc 16. According to the RIFLE classification. How would the nurse interpret the following data? Serum creatinine increased x 1.5 or GFR decrease 25%; Urine output is 0.5 mL/kg/hr for more than 6 hours. a. Risk stage b. Injury stage c. Failure stage d. ESKD - a 17. A patient has been diagnosed with AKI, but the cause is uncertain. The nurse prepares patient education material about which diagnostic test? a. Flat plate of the abdomen b. Renal ultrasonography c. Computed tomography d. Kidney biopsy - d 18. A patient is in the diuretic phase of AKI. During this phase, what is the nurse mainly concerned about? a. Assessing for hypertension and fluid overload b. Monitoring for hypovolemia and electrolyte loss c. Adjusting the dosage of diuretic medications d. Balancing diuretic therapy with intake - b 19. A patient with prerenal azotemia is administered to a fluid challenge. IN evaluating response to the therapy, which outcome indicates that the goal was met? a. Patient reports feeling better and indicate an eagerness to go home b. Patient produces urine soon after the initial bolus c. The therapy is completed without adverse effects d. The health care provider orders a diuretic when the challenge is complete - b 20. The nurse is caring for a patient with AKI and notes a trend of increasingly elevated BUN levels.How does the nurse interpret this information? a. Breakdown of muscle for protein which leads to an increase in azotemia b. Sign of urinary retention and decreased urinary output c. Expected trend that can be reversed by increasing dietary protein d. Ominous sign of impending irreversible kidney failure - a 21. The nurse is caring for a patient with AKI that developed after a severe anaphylactic reaction. What is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient? a. Correct fluid volume by administering IV normal saline b. Maintain a mean arterial pressure (MAP) of 65 mm Hg. c. Prevent kidney infections by administering antibiotics d. Give antihistamines to prevent allergic response - b 22. A patient sustained extensive burns and depletion of vascular volume. The nurse expects which changes in vital signs and urinary function? a. Decreased urine output, hypotension, tachycardia b. Increased urine output, hypertension, tachycardia c. Bradycardia, hypotension, polyuria d. Dysrhythmias, hypertension, oliguria - a 23. The nurse is taking a history of a patient at risk for kidney failure. What does the nurse ask the patient about during the interview? (SATA) a. Exposure to nephrotoxic chemicals b. Increased appetite c. History of diabetes mellitus, hypertension, systemic lupus erythematosus d. Recent surgery, trauma, or transfusions e. Leakage of urine when coughing or laughing f. Recent or prolonged use of antibiotics and NSAIDs - acdf 24. Which disorder could be a complication from AKI? a. Heart failure b. Diabetes mellitus c. Kidney cancer d. Compartment syndrome - a 25. A patient with AKI is ill and has a poor appetite. What would the health care team try first? a. IV normal saline to prevent dehydration b. Familiar food brought by the family c. Nasogastric tube for enteral feedings d. Oral supplements designed for kidney patients - d 26. The nurse is caring for a patient with AKI who does not have signs or symptoms fo fluid overload. A fluid challenge is performed to promote kidney perfusion by doing what? a. Administering normal saline 500 to 1000 mL infused over 1 hour b. Administering drugs to suppress aldosterone release c. Instilling warm, sterile normal saline into the bladder d. Having the patient drink several large glasses of water - a 27. Which signs/symptoms does the nurse expect to see in the patient with AKI that has progressed in severity? (SATA) a. Oliguria b. Hypotension c. Shortness of breath d. Pulmonary crackles e. Weight loss - acd 28. A patient has AKI related to nephrotoxins. In order to maintain cell integrity, improve GFR, and improve blood flow to the kidneys, which type of medication does the nurse anticipate the health care provider will prescribe? a. Loop diuretics b. Alpha-adrenergic blockers c. Beta blockers d. Calcium channel blockers - d 29. A patient with AKI has a high rate of catabolism. What is this related to? a. Increased levels of catecholamines, cortisol, and glucagon b. Inability to excrete excess electrolytes c. Conversion of body fat into glucose d. Presence of retained nitrogenous wastes - a