Chapter 49: Nursing Management: Acute Kidney Injury and Chronic
Kidney Disease: Lewis’s Medical-Surgical Nursing, 5th Edition
1. The nurse is caring for a patient who has had an insertion of an arteriovenous graft
(AVG) in the right forearm and has symptoms of pain and coldness of the right fingers.
Which of the following actions should the nurse take?
A. Elevate the patient's arm above the level of the heart.
B. Report the patient's symptoms to the health care provider.
C. Remind the patient about the need to take a daily low-dose Aspirin tablet.
D. Educate the patient about the normal vascular response after AVG insertion.
Answer: B
Explanation: The symptoms of pain and coldness suggest distal ischemia (steal syndrome), a
complication where the graft diverts blood flow away from the distal limb. This requires
immediate medical evaluation and possible revision of the graft.
2. The nurse is caring for a patient with acute kidney injury (AKI) who has an arterial
blood pH of 7.30. Which of the following assessment findings should the nurse
anticipate?
A. Vasodilation
B. Poor skin turgor
C. Bounding pulses
D. Rapid respirations
Answer: D
Explanation: Metabolic acidosis is a common complication of AKI. The body compensates
by increasing the respiratory rate to blow off carbon dioxide (Kussmaul respirations), which
helps to raise the blood pH.
3. The nurse is caring for a patient who has been admitted with a severe crush injury
after an industrial accident. Which of the following laboratory results is most important
to report to the health care provider?
A. Serum creatinine level 190 mcmol/L
B. Serum potassium level 6.5 mmol/L
C. White blood cell count 11.5 x 10^9/L
D. Blood urea nitrogen (BUN) 18 mmol/L
Answer: B
Explanation: Crush injuries can cause massive release of potassium from damaged cells,
leading to severe hyperkalemia. A potassium level of 6.5 mmol/L is critically high and can
cause fatal cardiac arrhythmias, requiring immediate treatment.
4. The nurse is caring for a patient with acute glomerulonephritis, acute kidney injury
(AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the
following parameters should the nurse assess to evaluate the effectiveness of the
medication?
,A. Urine output
B. Calcium level
C. Cardiac rhythm
D. Neurological status
Answer: C
Explanation: Calcium gluconate is administered in severe hyperkalemia to stabilize the
cardiac cell membranes and prevent life-threatening dysrhythmias. The nurse should monitor
the ECG for normalization of rhythm and wave patterns.
5. The nurse is caring for a patient with stage 2 chronic kidney disease (CKD) who is
scheduled for an intravenous pyelogram (IVP). Which of the following prescriptions for
the patient should the nurse question?
A. NPO for 6 hours before IVP procedure
B. Normal saline 500 mL IV before procedure
C. Ibuprofen 400 mg PO PRN for pain
D. Dulcolax suppository 4 hours before IVP procedure
Answer: C
Explanation: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which is
nephrotoxic. Its use should be avoided in patients with CKD, especially when they are also
being exposed to IV contrast dye for the IVP, which is also potentially nephrotoxic.
6. The nurse is teaching a patient with stage 5 chronic kidney disease (CKD) about
management of CKD. Which of the following patient statements indicate that the
teaching was effective?
A. "I need to try to get more protein from dairy products."
B. "I will try to increase my intake of fruits and vegetables."
C. "I will measure my urinary output each day to help calculate the amount I can drink."
D. "I need to take the erythropoietin to boost my immune system and help prevent infection."
Answer: C
Explanation: In end-stage renal disease (ESRD), fluid intake is often restricted. Measuring
daily urine output helps the patient determine a safe daily fluid allowance to prevent fluid
overload. Dairy products are high in phosphorus, many fruits/vegetables are high in
potassium, and erythropoietin stimulates red blood cell production, not the immune system.
7. The nurse is caring for a patient with chronic kidney disease (CKD) who is
prescribed calcium carbonate. Which of the following parameters should the nurse
assess in order to determine the effectiveness of the treatment?
A. Blood pressure
B. Phosphate level
C. Neurological status
D. Creatinine clearance
Answer: B
Explanation: Calcium carbonate is used as a phosphate binder in CKD. It works by binding
dietary phosphorus in the gut, preventing its absorption, thereby lowering serum phosphate
levels. Its effectiveness is evaluated by monitoring the serum phosphate level.
,8. Which of the following assessments should the nurse complete before administering
sodium polystyrene sulphonate to a patient with hyperkalemia?
A. Blood urea nitrogen (BUN) and creatinine
B. Blood glucose level
C. Patient's bowel sounds
D. Level of consciousness (LOC)
Answer: C
Explanation: Sodium polystyrene sulphonate (Kayexalate) can cause constipation or even
bowel necrosis, especially in patients with decreased bowel motility. Assessing for the
presence of normal bowel sounds ensures the patient has a functional GI tract before
administration.
9. The nurse is teaching a patient who is receiving hemodialysis about appropriate
dietary choices. Which of the following menu choices by the patient indicates that the
teaching has been effective?
A. Scrambled eggs, English muffin, and apple juice
B. Oatmeal with cream, half a banana, and herbal tea
C. Split-pea soup, whole-wheat toast, and nonfat milk
D. Cheese sandwich, tomato soup, and cranberry juice
Answer: A
Explanation: This option provides high-quality protein (eggs) and is low in potassium (apple
juice, English muffin). The other options are high in potassium (banana, tomato soup, split-
pea soup), phosphorus (dairy products like cream, milk, cheese), or sodium (cheese,
processed soup).
10. The nurse is preparing to administer calcium carbonate to a patient with chronic
kidney disease (CKD). Which of the following laboratory results should the nurse check
prior to administration?
A. Creatinine
B. Potassium
C. Total cholesterol
D. Serum phosphate
Answer: D
Explanation: If the serum phosphate level is high, administering calcium can lead to the
precipitation of calcium-phosphate crystals in soft tissues (metastatic calcification). The
phosphate level should be controlled before giving calcium-based binders.
11. Which of the following information is most useful to the nurse in evaluating
improvement in kidney function for a patient who is hospitalized with acute kidney
injury (AKI)?
A. Blood urea nitrogen (BUN) level
B. Urine output
C. Creatinine level
D. Calculated glomerular filtration rate (GFR)
Answer: D
, Explanation: The GFR is the best overall indicator of kidney function because it estimates
the volume of blood filtered by the glomeruli each minute. BUN and creatinine can be
influenced by other factors like dehydration, and urine output does not always correlate with
the filtering capacity of the kidneys.
12. The nurse is caring for a patient who requires vascular access for hemodialysis and
asks the nurse what the differences are between an arteriovenous (AV) fistula and a
graft. Which of the following information should the nurse explain is an advantage of
the fistula?
A. Is much less likely to clot.
B. Increases patient mobility.
C. Accommodates larger needles.
D. Can be used sooner after surgery.
Answer: A
Explanation: AV fistulas have a significantly lower rate of thrombosis and infection
compared to synthetic grafts because they are created from the patient's own vessels. They do
take longer to mature before they can be used.
13. The nurse is caring for a patient with a left arm arteriovenous fistula. Which of the
following actions should the nurse include in the plan of care to maintain the patency of
the fistula?
A. Check the fistula site for a bruit and thrill.
B. Assess the rate and quality of the left radial pulse.
C. Compare blood pressures in the left and right arms.
D. Irrigate the fistula site with saline every 8--12 hours.
Answer: A
Explanation: Palpating for a thrill (vibration) and auscultating for a bruit (whooshing sound)
over the fistula are essential assessments that confirm adequate blood flow and patency.
Blood pressures should never be taken on the fistula arm, and the fistula should only be
accessed by trained dialysis staff.
14. The nurse is caring for a patient who has had progressive chronic kidney disease
(CKD) for several years and is starting hemodialysis. Which of the following
information about diet should the nurse include in patient teaching?
A. Increased calories are needed because glucose is lost during hemodialysis.
B. Unlimited fluids are allowed since retained fluid is removed during dialysis.
C. More protein will be allowed because of the removal of urea and creatinine by dialysis.
D. Dietary sodium and potassium are unrestricted because these levels are normalized by
dialysis.
Answer: C
Explanation: Hemodialysis removes nitrogenous waste products, allowing for a less
restrictive protein intake. However, fluid, sodium, and potassium restrictions typically remain
in place to manage interdialytic weight gain and prevent electrolyte imbalances.
Kidney Disease: Lewis’s Medical-Surgical Nursing, 5th Edition
1. The nurse is caring for a patient who has had an insertion of an arteriovenous graft
(AVG) in the right forearm and has symptoms of pain and coldness of the right fingers.
Which of the following actions should the nurse take?
A. Elevate the patient's arm above the level of the heart.
B. Report the patient's symptoms to the health care provider.
C. Remind the patient about the need to take a daily low-dose Aspirin tablet.
D. Educate the patient about the normal vascular response after AVG insertion.
Answer: B
Explanation: The symptoms of pain and coldness suggest distal ischemia (steal syndrome), a
complication where the graft diverts blood flow away from the distal limb. This requires
immediate medical evaluation and possible revision of the graft.
2. The nurse is caring for a patient with acute kidney injury (AKI) who has an arterial
blood pH of 7.30. Which of the following assessment findings should the nurse
anticipate?
A. Vasodilation
B. Poor skin turgor
C. Bounding pulses
D. Rapid respirations
Answer: D
Explanation: Metabolic acidosis is a common complication of AKI. The body compensates
by increasing the respiratory rate to blow off carbon dioxide (Kussmaul respirations), which
helps to raise the blood pH.
3. The nurse is caring for a patient who has been admitted with a severe crush injury
after an industrial accident. Which of the following laboratory results is most important
to report to the health care provider?
A. Serum creatinine level 190 mcmol/L
B. Serum potassium level 6.5 mmol/L
C. White blood cell count 11.5 x 10^9/L
D. Blood urea nitrogen (BUN) 18 mmol/L
Answer: B
Explanation: Crush injuries can cause massive release of potassium from damaged cells,
leading to severe hyperkalemia. A potassium level of 6.5 mmol/L is critically high and can
cause fatal cardiac arrhythmias, requiring immediate treatment.
4. The nurse is caring for a patient with acute glomerulonephritis, acute kidney injury
(AKI), and hyperkalemia who is prescribed calcium gluconate IV. Which of the
following parameters should the nurse assess to evaluate the effectiveness of the
medication?
,A. Urine output
B. Calcium level
C. Cardiac rhythm
D. Neurological status
Answer: C
Explanation: Calcium gluconate is administered in severe hyperkalemia to stabilize the
cardiac cell membranes and prevent life-threatening dysrhythmias. The nurse should monitor
the ECG for normalization of rhythm and wave patterns.
5. The nurse is caring for a patient with stage 2 chronic kidney disease (CKD) who is
scheduled for an intravenous pyelogram (IVP). Which of the following prescriptions for
the patient should the nurse question?
A. NPO for 6 hours before IVP procedure
B. Normal saline 500 mL IV before procedure
C. Ibuprofen 400 mg PO PRN for pain
D. Dulcolax suppository 4 hours before IVP procedure
Answer: C
Explanation: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which is
nephrotoxic. Its use should be avoided in patients with CKD, especially when they are also
being exposed to IV contrast dye for the IVP, which is also potentially nephrotoxic.
6. The nurse is teaching a patient with stage 5 chronic kidney disease (CKD) about
management of CKD. Which of the following patient statements indicate that the
teaching was effective?
A. "I need to try to get more protein from dairy products."
B. "I will try to increase my intake of fruits and vegetables."
C. "I will measure my urinary output each day to help calculate the amount I can drink."
D. "I need to take the erythropoietin to boost my immune system and help prevent infection."
Answer: C
Explanation: In end-stage renal disease (ESRD), fluid intake is often restricted. Measuring
daily urine output helps the patient determine a safe daily fluid allowance to prevent fluid
overload. Dairy products are high in phosphorus, many fruits/vegetables are high in
potassium, and erythropoietin stimulates red blood cell production, not the immune system.
7. The nurse is caring for a patient with chronic kidney disease (CKD) who is
prescribed calcium carbonate. Which of the following parameters should the nurse
assess in order to determine the effectiveness of the treatment?
A. Blood pressure
B. Phosphate level
C. Neurological status
D. Creatinine clearance
Answer: B
Explanation: Calcium carbonate is used as a phosphate binder in CKD. It works by binding
dietary phosphorus in the gut, preventing its absorption, thereby lowering serum phosphate
levels. Its effectiveness is evaluated by monitoring the serum phosphate level.
,8. Which of the following assessments should the nurse complete before administering
sodium polystyrene sulphonate to a patient with hyperkalemia?
A. Blood urea nitrogen (BUN) and creatinine
B. Blood glucose level
C. Patient's bowel sounds
D. Level of consciousness (LOC)
Answer: C
Explanation: Sodium polystyrene sulphonate (Kayexalate) can cause constipation or even
bowel necrosis, especially in patients with decreased bowel motility. Assessing for the
presence of normal bowel sounds ensures the patient has a functional GI tract before
administration.
9. The nurse is teaching a patient who is receiving hemodialysis about appropriate
dietary choices. Which of the following menu choices by the patient indicates that the
teaching has been effective?
A. Scrambled eggs, English muffin, and apple juice
B. Oatmeal with cream, half a banana, and herbal tea
C. Split-pea soup, whole-wheat toast, and nonfat milk
D. Cheese sandwich, tomato soup, and cranberry juice
Answer: A
Explanation: This option provides high-quality protein (eggs) and is low in potassium (apple
juice, English muffin). The other options are high in potassium (banana, tomato soup, split-
pea soup), phosphorus (dairy products like cream, milk, cheese), or sodium (cheese,
processed soup).
10. The nurse is preparing to administer calcium carbonate to a patient with chronic
kidney disease (CKD). Which of the following laboratory results should the nurse check
prior to administration?
A. Creatinine
B. Potassium
C. Total cholesterol
D. Serum phosphate
Answer: D
Explanation: If the serum phosphate level is high, administering calcium can lead to the
precipitation of calcium-phosphate crystals in soft tissues (metastatic calcification). The
phosphate level should be controlled before giving calcium-based binders.
11. Which of the following information is most useful to the nurse in evaluating
improvement in kidney function for a patient who is hospitalized with acute kidney
injury (AKI)?
A. Blood urea nitrogen (BUN) level
B. Urine output
C. Creatinine level
D. Calculated glomerular filtration rate (GFR)
Answer: D
, Explanation: The GFR is the best overall indicator of kidney function because it estimates
the volume of blood filtered by the glomeruli each minute. BUN and creatinine can be
influenced by other factors like dehydration, and urine output does not always correlate with
the filtering capacity of the kidneys.
12. The nurse is caring for a patient who requires vascular access for hemodialysis and
asks the nurse what the differences are between an arteriovenous (AV) fistula and a
graft. Which of the following information should the nurse explain is an advantage of
the fistula?
A. Is much less likely to clot.
B. Increases patient mobility.
C. Accommodates larger needles.
D. Can be used sooner after surgery.
Answer: A
Explanation: AV fistulas have a significantly lower rate of thrombosis and infection
compared to synthetic grafts because they are created from the patient's own vessels. They do
take longer to mature before they can be used.
13. The nurse is caring for a patient with a left arm arteriovenous fistula. Which of the
following actions should the nurse include in the plan of care to maintain the patency of
the fistula?
A. Check the fistula site for a bruit and thrill.
B. Assess the rate and quality of the left radial pulse.
C. Compare blood pressures in the left and right arms.
D. Irrigate the fistula site with saline every 8--12 hours.
Answer: A
Explanation: Palpating for a thrill (vibration) and auscultating for a bruit (whooshing sound)
over the fistula are essential assessments that confirm adequate blood flow and patency.
Blood pressures should never be taken on the fistula arm, and the fistula should only be
accessed by trained dialysis staff.
14. The nurse is caring for a patient who has had progressive chronic kidney disease
(CKD) for several years and is starting hemodialysis. Which of the following
information about diet should the nurse include in patient teaching?
A. Increased calories are needed because glucose is lost during hemodialysis.
B. Unlimited fluids are allowed since retained fluid is removed during dialysis.
C. More protein will be allowed because of the removal of urea and creatinine by dialysis.
D. Dietary sodium and potassium are unrestricted because these levels are normalized by
dialysis.
Answer: C
Explanation: Hemodialysis removes nitrogenous waste products, allowing for a less
restrictive protein intake. However, fluid, sodium, and potassium restrictions typically remain
in place to manage interdialytic weight gain and prevent electrolyte imbalances.
