Deck 16: Acute Kidney Injury

Question 1

The patient has elevated blood urea nitrogen (BUN)and serum creatinine levels with a normal BUN/creatinine ratio.These levels most likely indicate

A) increased nitrogen intake.
B) acute kidney injury, such as acute tubular necrosis (ATN).
C) hypovolemia.
D) fluid resuscitation.

Answer 1

acute kidney injury, such as acute tubular necrosis (ATN).

Question 2

The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis.The patient asks if he will need dialysis for the rest of his life.Which of the following would be the best response?

A) "Unfortunately, kidney injury is not reversible; it is permanent."
B) "Kidney function usually returns within 2 weeks."
C) "You will know for sure if you start urinating a lot all at once."
D) "Recovery is possible, but it may take several months."

Answer 2

"Recovery is possible, but it may take several months."

Question 3

A normal urine output is considered to be

A) 80 to 125 mL/min.
B) 180 L/day.
C) 80 mL/min.
D) 1 to 2 L/day.

Answer 3

1 to 2 L/day.

Question 4

The critical care nurse knows that in critically ill patients,renal dysfunction

A) is a very rare problem.
B) affects nearly two thirds of patients.
C) has a low mortality rate once renal replacement therapy has been initiated.
D) has little effect on morbidity, mortality, or quality of life.

Question 5

The nurse is caring for a patient who has undergone major abdominal surgery.The nurse notices that the patient's urine output has been less than 20 mL/hour for the past 2 hours.The patient's blood pressure is 100/60 mm Hg,and the pulse is 110 beats/min.Previously,the pulse was 90 beats/min with a blood pressure of 120/80 mm Hg.The nurse should

A) contact the provider and expect a prescription for a normal saline bolus.
B) wait until the provider makes rounds to report the assessment findings.
C) continue to evaluate urine output for 2 more hours.
D) ignore the urine output, as this is most likely postrenal in origin.

Question 6

Renin plays a role in blood pressure regulation by

A) activating the renin-angiotensin-aldosterone cascade.
B) suppressing angiotensin production.
C) decreasing sodium reabsorption.
D) inhibiting aldosterone release.

Question 7

The patient is admitted with complaints of general malaise and fatigue,along with a decreased urinary output.The patient's urinalysis shows coarse,muddy brown granular casts and hematuria.The nurse determines that the patient has:

A) acute kidney injury from a prerenal condition.
B) acute kidney injury from postrenal obstruction.
C) intrarenal disease, probably acute tubular necrosis.
D) a urinary tract infection.

Question 8

Acute kidney injury from postrenal etiology is caused by

A) obstruction of the flow of urine.
B) conditions that interfere with renal perfusion.
C) hypovolemia or decreased cardiac output.
D) conditions that act directly on functioning kidney tissue.

Question 9

The term used to describe an increase in blood urea nitrogen (BUN)and serum creatinine is

A) oliguria.
B) azotemia.
C) acute kidney injury.
D) prerenal disease.

Question 10

The nurse is caring for a patient who has sustained blunt trauma to the left flank area,and is evaluating the patient's urinalysis results.The nurse should become concerned when

A) creatinine levels in the urine are similar to blood levels of creatinine.
B) sodium and chloride are found in the urine.
C) urine uric acid levels have the same values as serum levels.
D) red blood cells and albumin are found in the urine.

Question 11

The patient's serum creatinine level is 0.7 mg/dL.The expected BUN level should be

A) 1 to 2 mg/dL.
B) 7 to 14 mg/dL.
C) 10 to 20 mg/dL.
D) 20 to 30 mg/dL.

Question 12

In calculating the glomerular filtration rate (GFR)results for women,the creatinine clearance is usually:

A) the same as for men.
B) greater than that for men.
C) multiplied by 0.85.
D) multiplied by 1.15.

Question 13

A normal glomerular filtration rate is

A) less than 80 mL/min.
B) 80 to 125 mL/min.
C) 125 to 180 mL/min.
D) more than 189 mL/min.

Question 14

Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal.The most common intrarenal condition is

A) prolonged ischemia.
B) exposure to nephrotoxic substances.
C) acute tubular necrosis (ATN).
D) hypotension for several hours.

Question 15

In determining the glomerular filtration rate (GFR)or creatinine clearance,a 24-hour urine is obtained.If a reliable 24-hour urine collection is not possible,

A) it is not possible to determine the GFR.
B) the BUN may be used to determine renal function.
C) an elevated BUN/creatinine ratio can be used.
D) a standardized formula may be used to calculate GFR.

Question 16

Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who

A) has been on aminoglycosides for the past 6 days
B) has a history of controlled hypertension with a blood pressure of 138/88 mm Hg
C) was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks
D) has a history of fluid overload as a result of heart failure

Question 17

The nurse is caring for an elderly patient who was admitted with renal insufficiency.An expected laboratory finding for this patient may be

A) an increased glomerular filtration rate (GFR).
B) a normal serum creatinine level.
C) increased ability to excrete drugs.
D) hypokalemia.

Question 18

The patient is complaining of severe flank pain when he tries to urinate.His urinalysis shows sediment and crystals along with a few bacteria.Using this information along with the clinical picture,the nurse realizes that the patient's condition is

A) prerenal.
B) postrenal.
C) intrarenal.
D) not renal related.

Question 19

The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure.To detect signs of contrast-induced kidney injury,the nurse should

A) not be concerned unless urine output decreases.
B) evaluate the patient's serum creatinine for up to 72 hours after the procedure.
C) obtain an order for a renal ultrasound.
D) evaluate the patient's postvoid residual volume to detect intrarenal injury.

Question 20

The most common cause of acute kidney injury in critically ill patients is

A) sepsis.
B) fluid overload.
C) medications.
D) hemodynamic instability.

Question 21

The patient has just returned from having an arteriovenous fistula placed.The patient asks,"When will they be able to use this and take this other catheter out?" The nurse should reply,

A) "It can be used immediately, so the catheter can come out anytime."
B) "It will take 2 to 4 weeks to heal before it can be used."
C) "The fistula will be usable in about 4 to 6 weeks."
D) "The fistula was made using graft material, so it depends on the manufacturer."

Question 22

Continuous venovenous hemofiltration is used to

A) remove fluids and solutes through the process of convection.
B) remove plasma water in cases of volume overload.
C) remove plasma water and solutes by adding dialysate.
D) combine ultrafiltration, convection, and dialysis.

Question 23

Continuous venovenous hemodialysis is used to

A) remove fluids and solutes through the process of convection.
B) remove plasma water in cases of volume overload.
C) remove plasma water and solutes by adding dialysate.
D) combine ultrafiltration, convection and dialysis

Question 24

The patient is getting hemodialysis for the second time when he complains of a headache and nausea and,a little later,of becoming confused.The nurse realizes these are symptoms of

A) dialyzer membrane incompatibility.
B) a shift in potassium levels.
C) dialysis disequilibrium syndrome.
D) hypothermia.

Question 25

The patient is in need of immediate hemodialysis,but has no vascular access.The nurse prepares the patient for insertion of

A) a percutaneous catheter at the bedside.
B) a percutaneous tunneled catheter at the bedside.
C) an arteriovenous fistula.
D) an arteriovenous graft.

Question 26

The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week.The patient complains of general malaise and is tachypneic.An arterial blood gas shows that the patient's pH is 7.19,with a PCO₂ of 30 mm Hg and a bicarbonate level of 13 mEq/L.The nurse prepares to

A) administer morphine to slow the respiratory rate.
B) prepare for intubation and mechanical ventilation.
C) administer intravenous sodium bicarbonate.
D) cancel tomorrow's dialysis session.

Question 27

A 100-kg patient gets hemodialysis 3 days a week.In planning the care for this patient,the nurse recommends

A) a diet of 2500 to 3500 kcal per day.
B) protein intake of less than 50 grams per day.
C) potassium intake of 10 mEq per day.
D) fluid intake of less than 500 mL per day.

Question 28

The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place.In caring for this patient,the nurse should

A) apply a sterile gauze dressing to maintain sterility.
B) replace the transparent dressing every 10 days to prevent manipulation.
C) assess the catheter site for redness and/or swelling.
D) use the catheter for drawing blood samples to reduce patient discomfort.

Question 29

The patient is in a progressive care unit following arteriovenous fistula implantation in his left upper arm,and is due to have blood drawn with his next set of vital signs and assessment.When the nurse assesses the patient,the nurse should

A) draw blood from the left arm.
B) take blood pressures from the left arm.
C) start a new intravenous line in the left lower arm.
D) auscultate the left arm for a bruit and palpate for a thrill.

Question 30

The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT).In doing so,the nurse should

A) assess that the blood tubing is warm to the touch.
B) assess the hemofilter every 6 hours for clotting.
C) cover the dialysis lines to protect them from light.
D) use clean technique during vascular access dressing changes.

Question 31

The patient's potassium level is 7.0 mEq/L.Besides dialysis,which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?

A) Sodium polystyrene sulfonate
B) Sodium polystyrene sulfonate with sorbitol
C) Regular insulin
D) Calcium gluconate

Question 32

Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis

A) is more frequently used for acute kidney injury.
B) uses the patient's own semipermeable membrane (peritoneal membrane).
C) is not useful in cases of drug overdose or electrolyte imbalance.
D) is not indicated in cases of water intoxication.

Question 33

What is a minimally acceptable urine output for a patient weighing 75 kg?

A) Less than 30 mL/hour
B) 37 mL/hour
C) 80 mL/hour
D) 150 mL/hour

Question 34

Continuous renal replacement therapy (CRRT)differs from conventional intermittent hemodialysis in that

A) a hemofilter is used to facilitate ultrafiltration.
B) it provides faster removal of solute and water.
C) it does not allow diffusion to occur.
D) the process removes solutes and water slowly.

Question 35

Daily weights are being recorded for the patient with a urine output that has been less than the intravenous and oral intake.The weight yesterday was 97.5 kg.This morning it is 99 kg.The nurse understands that this corresponds to a(n)

A) fluid retention of 1.5 liters.
B) fluid loss of 1.5 liters.
C) equal intake and output due to insensible losses.
D) fluid loss of 0.5 liters.

Question 36

The nurse is assessing a patient with a new arteriovenous fistula,but does not hear a bruit or feel a thrill.Pulses distal to the fistula are not palpable.The nurse should

A) reassess the patient in an hour.
B) raise the arm above the level of the patient's heart.
C) notify the provider immediately.
D) apply warm packs to the fistula site and reassess.

Question 37

The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury.The catheter has been in place for 5 days.The nurse should

A) prepare to assist with a routine dialysis catheter change.
B) evaluate the patient for signs and symptoms of infection.
C) teach the patient that the catheter is designed for long-term use.
D) use one of the three lumens for fluid administration.

Question 38

Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used to

A) remove plasma water in cases of volume overload.
B) remove fluids and solutes through the process of convection.
C) remove plasma water and solutes by adding dialysate.
D) combine ultrafiltration, convection, and dialysis.

Question 39

The removal of plasma water and some low-molecular weight particles by using a pressure or osmotic gradient is known as

A) dialysis.
B) diffusion.
C) clearance.
D) ultrafiltration.

Question 40

The patient is admitted to the unit with the diagnosis of rhabdomyolysis.The patient is started on intravenous (IV)fluids and IV mannitol.What action by the nurse is best?

A) Assess the patient's hearing.
B) Assess the patient's lungs.
C) Decrease IV fluids once the diuretic has been administered.
D) Give extra doses before giving radiological contrast agents.

Question 41

The patient is on intake and output (I&O),as well as daily weights.The nurse notes that output is considerably less than intake over the last shift,and daily weight is 1 kg more than yesterday.The nurse should

A) draw a trough level after the next dose of antibiotic.
B) obtain an order to place the patient on fluid restriction.
C) assess the patient's lungs.
D) insert an indwelling catheter.

Question 42

An advantage of peritoneal dialysis is that

A) peritoneal dialysis is time intensive.
B) a decreased risk of peritonitis exists.
C) biochemical disturbances are corrected rapidly.
D) the danger of hemorrhage is minimal.

Question 43

Noninvasive diagnostic procedures used to determine kidney function include which of the following? (Select all that apply.)

A) Kidney, ureter, bladder ( KUB ) x-ray
B) Renal ultrasound
C) Magnetic resonance imaging ( MR)
D) Intravenous pyelography ( IVP )
E) Renal angiography

Question 44

Identify which substances in the glomerular filtrate would indicate a problem with renal function.(Select all that apply.)

A) Protein
B) Sodium
C) Creatinine
D) Red blood cells
E) Uric acid

Question 45

The patient is admitted with acute kidney injury from a postrenal cause.Acceptable treatments for that diagnosis include: (Select all that apply.)

A) bladder catheterization.
B) increasing fluid volume intake.
C) ureteral stenting.
D) placement of nephrostomy tubes.
E) increasing cardiac output.

Question 46

Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.)

A) Hypotension
B) Dysrhythmias
C) Muscle cramps
D) Hemolysis
E) Air embolism

Question 47

The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier.Blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; the patient has not voided in 8 hours,and the bladder is not distended.The nurse anticipates a prescription for "stat" administration of

A) a blood transfusion.
B) fluid replacement with 0.45% saline.
C) infusion of an inotropic agent.
D) an antiemetic.

Question 48

The patient is in the critical care unit and will receive dialysis this morning.The nurse will (Select all that apply.)

A) evaluate morning laboratory results and report abnormal results.
B) administer the patient's antihypertensive medications.
C) assess the dialysis access site and report abnormalities.
D) weigh the patient to monitor fluid status.
E) give all medications except for antihypertensive medications.

Question 49

The most common reasons for initiating dialysis in acute kidney injury include which of the following? (Select all that apply.)

A) Acidosis
B) Hypokalemia
C) Volume overload
D) Hyperkalemia
E) Uremia

Question 50

The nurse is caring for a patient receiving peritoneal dialysis.The patient suddenly complains of abdominal pain and chills.The patient's temperature is elevated.The nurse should

A) assess peritoneal dialysate return.
B) check the patient's blood sugar.
C) evaluate the patient's neurological status.
D) inform the provider of probable visceral perforation.