N123 Acute Kidney Injury – Flashcards
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What causes prerenal acute kidney injury? 1 Release of nephrotoxins 2 Reduced renal blood flow 3 Urine reflux into renal pelvis 4 Presence of extrarenal tumors
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2 Prerenal acute kidney injury can be caused by a reduced flow of blood to the kidneys. A release of nephrotoxins is an intrarenal cause of acute kidney injury. Urine reflux into the renal pelvis and the presence of extrarenal tumors are postrenal causes of acute kidney injury. Text Reference - p. 1103
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Which nursing intervention should the nurse implement while preparing a high-risk patient with contrast-induced nephropathy for magnetic resonance imaging? 1 Give low-fat foods 2 Give low-calorie foods 3 Provide plenty of fluids 4 Provide a high-protein diet
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3 Contrast agents accumulate in the nephrons, causing their death and resulting in renal failure. Therefore, patients who have a high risk of contrast-induced nephropathy should be well hydrated. Fatty foods are rich in calories and should be given to provide energy. High-calorie foods should be included in a patient's diet. A high-protein diet causes increased levels of nitrogenous waste in the blood. Therefore, a low-protein diet should be given to this patient. Text Reference - p. 1105
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The student nurse is preparing a dietary chart for a patient with acute kidney injury. Which foods included by the nurse in the diet chart need correction? 1 Foods rich in fiber 2 Foods rich in potassium 3 Foods rich in fatty acids 4 Foods rich in carbohydrates
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2 Hyperkalemia is a complication associated with acute kidney injury. Foods rich in potassium will further increase the potassium level in the blood; these foods should not be included in the patient's diet plan. Foods rich in fiber do not cause any harm to the patient's health and can be included. Fats and carbohydrates provide adequate energy; foods rich in fatty acids and carbohydrates can be included in the patient's diet.
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The patient has a form of glomerular inflammation that is progressing rapidly. The patient is gaining weight and the urine output is declining steadily. What is the priority nursing intervention? 1 Monitor the patient's cardiac status 2 Teach the patient about hand washing 3 Obtain a serum specimen for electrolytes 4 Increase direct observation of the patient
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1 The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions, but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as prescribed by the health care provider. Text Reference - p. 1110
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Which condition is a result of severe metabolic acidosis in patients with acute kidney injury? 1 Asterixis 2 Proteinuria 3 Hydronephrosis 4 Kussmaul respirations
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4 Severe acidosis causes a patient to take deep and rapid breaths—called Kussmaul respirations—in an effort to increase the exhalation of carbon dioxide. Asterixis is a neurologic change associated with acute kidney injury due to the accumulation of metabolic waste in the brain and nervous system. Dysfunction of the glomerular membrane due to acute kidney injury leads to proteinuria. Hydronephrosis refers to dilation of the kidneys and is a postrenal cause of acute kidney injury. Text Reference - p. 1104
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When assessing the mental status of a patient in acute renal failure, the nurse recognizes that abnormal findings are most likely caused by: 1 Anger related to denial of chronic illness 2 Delirium related to hypoxia of brain cells 3 Confusion related to an increased urea level 4 Aggression related to possible underlying comorbidities
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3 In renal disease, urea is not filtered out of the blood by the kidneys and therefore accumulates in the blood. This results in toxicity to brain tissue, causing confusion. Anger is a possible emotional reaction, but it does not manifest as a change of mental status. Delirium related to hypoxia of brain cells is not a complication seen with acute renal failure. Aggression is not necessarily related to acute renal failure. Text Reference - p. 1108
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Which is a clinical manifestation of acute kidney injury? 1 Oliguria 2 Uremia 3 Anemia 4 Pruritus
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1 Oliguria is a sign of acute kidney injury. Uremia, anemia, and pruritus are signs of chronic kidney injury. Test-Taking Tip: Whether you are taking a written or clinical exam, budget your time. Remember that some tasks or questions may require more time than others. Text Reference - p. 1103
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A patient has renal failure. The nurse, reviewing the lab results, recognizes which finding as indicative of the diminished renal function associated with the diagnosis? 1 Hypokalemia 2 Increased serum urea and serum creatinine 3 Anemia and decreased blood urea nitrogen 4 Increased serum albumin and hyperkalemia
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2 Renal failure, whether acute or chronic, causes an increase in serum urea, creatinine, and blood urea nitrogen. Renal failure may also cause hyperkalemia and anemia and decrease serum albumin. However, it does not cause decreased blood urea nitrogen or increased serum albumin. Text Reference - p. 1102
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The nursing instructor asks the student nurse about fluid and electrolyte changes that occur in a patient with an acute kidney injury. Which statement by the student nurse indicates effective learning? 1 "The patient will have hypokalemia." 2 "The patient will have hypernatremia." 3 "The patient will have increased serum creatinine levels." 4 "The patient will have decreased levels of blood urea nitrogen."
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3 Creatinine is a waste product of muscle catabolism. Patients with acute kidney injury cannot remove body waste and it accumulates in the blood, which raises the serum creatinine level. Acute kidney injury is associated with an increased level of potassium, a decreased level of sodium, and a decreased level of blood urea nitrogen. Thus, the statements that the patient will have hypokalemia, hypernatremia, and decreased levels of blood urea nitrogen are incorrect. Text Reference - p. 1104
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While caring for a patient with an acute kidney injury, the patient complains of severe weakness and palpitations. The electrocardiogram reveals widening of the QRS complex and an elevated T wave. What complication does the nurse suspect in this patient? 1 Hyperkalemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperchloremia
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1 Hyperkalemia is associated with electrocardiographic changes like T-wave elevation, widening of the QRS complex, and ST-segment depression. A short QT interval and a small ST segment indicate hypercalcemia. Hypernatremia is characterized by a flat T wave. A depressed T wave is a characteristic of hyperchloremia. Text Reference - p. 1104
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The nurse caring for a patient with heart failure notes the patient has decreased urine output of 200 mL/day. Which laboratory finding aids in the diagnosis of prerenal azotemia in this patient? 1 Elevated blood urea nitrogen (BUN) 2 Normal creatinine level 3 Decreased sodium level 4 Decreased potassium level
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1 The patient with heart failure has a decreased circulating blood volume. This causes autoregulatory mechanisms to preserve blood flow to essential organs. Laboratory data for this patient will likely demonstrate an elevation in BUN, creatinine, and potassium. Prerenal azotemia results in a reduction in the excretion of sodium, increased sodium and water retention, and decreased urine output. Text Reference - p. 1102
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Which clinical manifestation of acute kidney injury may cause changes in an electrocardiogram? 1 Hyperkalemia 2 Fluid overload 3 Hyponatremia 4 Metabolic acidosis
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1 Acute or rapid development of hyperkalemia affects the heart and causes electrocardiographic changes such as peaked T waves, widening of the QRS complex, and ST-segment depression. Fluid overload may lead to pulmonary edema and heart failure. Uncontrolled hyponatremia may lead to the development of cerebral edema. Metabolic acidosis causes Kussmaul respirations. Text Reference - p. 1104
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A nurse planning care for a patient with acute renal failure recognizes that the interventions of highest priority are directly related to: 1 Ineffective coping 2 Excess fluid volume 3 Impaired gas exchange 4 Imbalanced nutrition: less than body requirements
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2 The issue of excess fluid volume is the primary problem of acute renal failure and the highest priority for the nurse in this situation. The major problem with acute renal failure is altered fluid and electrolyte balance, which, if not managed, can lead to permanent renal damage, cardiac complications, and death. The nursing diagnosis of ineffective coping is due to the acute severity of the illness. The nursing diagnosis of impaired gas exchange is related to excess fluid volume, such as in the development of pulmonary edema. The nursing diagnosis of imbalanced nutrition, less than body requirements, is due to a decrease in appetite as a result of the acute renal failure. Text Reference - p. 1106
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The nurse performs an admission assessment of a patient with acute renal failure. For which common complication does the nurse assess the patient? 1 Polyphagia 2 Hypernatremia 3 Hypotensive shock 4 Cardiac dysrhythmias
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4 Because the kidneys are not effectively removing waste products, including electrolytes, an increased potassium level (hyperkalemia) of more than 5.0 mEq/L is common in acute renal failure and places the patient at risk for cardiac arrhythmias. Patients usually experience anorexia, not an increase in hunger. Acute renal failure will likely manifest as hyponatremia. Hypotensive shock may be the result of a severe cardiac arrhythmia that is not treated. Text Reference - p. 1105
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Which is the most common cause of acute kidney injury? 1 Bladder cancer 2 Prostate cancer 3 Acute tubular necrosis 4 Malignant hypertension
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3 Although bladder cancer, prostate cancer, and malignant hypertension can precipitate acute kidney injury, acute tubular necrosis is the most common cause of acute kidney injury. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 1103
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A patient with acute kidney injury has hypovolemia. After an intravenous infusion of fluids, the nurse observes that the patient has no urine output and a blood pressure of 140/90 mm Hg. Which risk does the nurse anticipate in this patient? 1 Gall stones 2 Lung failure 3 Heart failure 4 Liver damage
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3 Heart failure is caused by an increase in the circulatory volume. An observation of a lack of urine output and increased blood pressure indicates a buildup of fluid in the body, and the patient is at risk of heart failure. Gallstones are caused by increased levels of cholesterol in the bile or an inability of the gallbladder to empty properly. Conditions such as pneumonia and chronic obstructive pulmonary disease decrease the amounts of air and blood that enter and exit the lungs, causing lung failure. Increased levels of liver enzymes are signs of liver damage. Text Reference - p. 1104
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Which finding indicates oliguria? 1 Urinary output of 350 mL/day 2 Urinary output of 450 mL/day 3 Urinary output of 550 mL/day 4 Urinary output of 650 mL/day
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1 A urinary output rate of less than 400 mL/day indicates oliguria; thus a urinary output of 350 mL/day suggests oliguria. Urine outputs of 450, 550, or 650 mL/day are considered normal. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. Text Reference - p. 1103
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The nurse reviews lab tests that have been prescribed for a patient in acute renal failure. Which is the best indicator of renal function? 1 Potassium 2 Creatinine 3 BUN (blood urea nitrogen) 4 ALT (alanine aminotransferase)
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2 Creatinine is the best indicator of renal function. Creatinine is a waste product of the skeletal muscles and is excreted through the kidneys. In renal failure, the kidneys are unable to excrete creatinine, leading to a serum level greater than the normal range of 0.2 to 1.0 mL/dL. Potassium excretion and regulation are impaired in acute renal failure, and potassium may therefore be increased. However, potassium may be increased for reasons other than renal disease, whereas increased creatinine is specific to renal disease. Blood urea nitrogen (BUN) is also used to measure kidney function, but other disorders such as dehydration may cause an increase in BUN. Alanine aminotransferase (ALT) is related to liver dysfunction, not renal dysfunction. Text Reference - p. 1104
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The nurse is caring for a patient with severe burns in the emergency department. His laboratory values reveal serum creatinine level of 5 mg/dL, and the glomerular filtration rate (GFR) has decreased by 75%. What stage of acute kidney failure is this patient exhibiting? 1 Risk 2 Injury 3 Failure 4 Loss
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3 As per the RIFLE (Risk, Injury, Failure, Loss, and End-stage) classification for staging acute kidney injury, this patient is at the Failure stage. When the GFR has decreased by 25%, the patient is at the Risk stage. The patient with a GFR that has decreased by 50% is at the Injury stage. The patient with persistent acute kidney failure experiences a complete loss of kidney function and is at the Loss stage. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. Text Reference - p. 1103
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When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention? 1 Weigh patient three times weekly 2 Increase dietary sodium and potassium 3 Provide a low-protein, high-carbohydrate diet 4 Restrict fluids according to previous daily loss
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4 Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. The patient also should be weighed daily, not just three times each week. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. Text Reference - p. 1107
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Which intervention should the nurse perform for a patient with acute kidney injury who is on hemodialysis? 1 Monitor bilirubin levels 2 Monitor the color of feces 3 Monitor blood glucose levels 4 Monitor for discharge at access site
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4 The nurse should monitor the access site for discharge because any discharge indicates infection. Patients with liver disorders should have their bilirubin levels monitored. Kidney injury is not associated with changes in bilirubin. The color of fecal matter and blood glucose levels do not need to be monitored. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 1106
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What are the postrenal causes of acute kidney injury? Select all that apply. 1 Renal calculi 2 Renal trauma 3 Prostate cancer 4 Kidney ischemia 5 Myoglobin release
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1, 2, 3 Renal calculi, trauma, and prostate cancer are postrenal causes of acute kidney injury. Intrarenal causes of acute kidney injury include kidney ischemia and myoglobin released from muscle cells. Text Reference - p. 1103
