Deck 27: Kidney Disorders and Therapeutic Management

Question 1

The patient is a gravida 6,para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C,and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter,which was placed into her right femoral access,and started on vasopressors with a fair response (BP,80/50 mm Hg; HR,122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis,the patient was begun on CVVH.Which of the statements best describes CVVH?

A) Complete renal replacement therapy requiring large volumes of ultrafiltrate and filter replacement
B) Complete renal replacement therapy that allows removal of solutes and modification of the volume and composition of extracellular fluid to occur evenly over time
C) Involves the introduction of sterile dialyzing fluid through an implanted catheter into the abdominal cavity, which relies on osmosis, diffusion, and active transport to help remove waste from the body
D) Complete renal replacement therapy that allows an exchange of fluid, solutes, and solvents across a semipermeable membrane at 100 to 300 mL/hr

Answer 1

Complete renal replacement therapy that allows removal of solutes and modification of the volume and composition of extracellular fluid to occur evenly over time

Question 2

To remove fluid during hemodialysis,a positive hydrostatic pressure is applied to the blood and a negative hydrostatic pressure is applied to the dialysate bath.This process is known as

A) ultrafiltration.
B) hemodialysis.
C) reverse osmosis.
D) colloid extraction.

Answer 2

ultrafiltration.

Question 3

Which electrolytes pose the most potential hazard if not within normal limits for a person with renal failure?

A) Phosphorous and calcium
B) Potassium and calcium
C) Magnesium and sodium
D) Phosphorous and magnesium

Answer 3

Potassium and calcium

Question 4

Which of the following IV solutions is contraindicated for patients with kidney or liver disease or in lactic acidosis?

A) D5W
B) 0.9% NaCl
C) Lactated Ringer solution
D) 0.45% NaCl

Question 5

What is a continuous venovenous hemodialysis filter permeable to?

A) Electrolytes
B) Red blood cells
C) Protein
D) Lipids

Question 6

A patient has acute tubular necrosis.The following blood work was noted: complete blood count shows a white blood cell count of 11,000 mm³,a hemoglobin of 8 g/dL,and a hematocrit of 30%.His chemistry panel shows serum potassium,4.5 mg/dL; serum sodium,135 mg/dL; serum calcium,8.5 mg/dL; BUN,20 mg/dL; and creatinine,1.5 mg/dL.What laboratory value(s)need(s)to be treated most immediately and why?

A) Administration of 5% dextrose in water and insulin because the patient is hyperkalemic and needs this level reduced
B) Administration of Epogen to treat anemia
C) Administration of a broad-spectrum antibiotic to treat the elevated blood cell count
D) Administration of a calcium supplement for low calcium

Question 7

A patient who receives peritoneal dialysis is seen in the intensive care unit with a 3-day history of flulike symptoms,including muscle cramps and low blood pressure.Which complication of peritoneal dialysis is the most likely problem for this patient?

A) Dehydration
B) Peritonitis
C) Fluid obstruction
D) Hernias

Question 8

A patient has been hospitalized for a subtotal gastrectomy.After the procedure,an infection developed that eventually had to be treated with gentamicin,an aminoglycoside antibiotic.After 3 days of administration,oliguria occurred,and subsequent laboratory values indicated elevated BUN and creatinine levels.The patient is transferred to the critical care unit with acute tubular necrosis.The fluid that is removed each hour is not called urine; it is known as

A) convection.
B) diffusion.
C) replacement fluid.
D) ultrafiltrate.

Question 9

To control azotemia,the recommended nutritional intake of protein is

A) .5 to 1.0 g/kg/day.
B) 1.2 to 1.5 g/kg/day.
C) 1.7 to 2.5 g/kg/day.
D) 2.5 to 3.5 g/kg/day.

Question 10

A patient has been hospitalized for a subtotal gastrectomy.After the procedure,an infection developed that eventually had to be treated with gentamicin,an aminoglycoside antibiotic.After 3 days of administration,oliguria occurred,and subsequent laboratory values indicated elevated BUN and creatinine levels.The patient is transferred to the critical care unit with acute tubular necrosis.Which dialysis method would be most appropriate for the patient's condition?

A) Peritoneal dialysis
B) Hemodialysis
C) Continuous renal replacement therapy
D) Continuous venovenous hemodialysis (CVVH)

Question 11

The patient is a gravida 6,para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C,and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter,which was placed into her right femoral access,and started on vasopressors with a fair response (BP,80/50 mm Hg; HR,122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis,the patient was begun on CVVH.Identify three complications of CVVH therapy.

A) Fat emboli, increased ultrafiltration, and hypertension
B) Hyperthermia, overhydration, and power surge
C) Air embolism, decreased inflow pressure, and electrolyte imbalance
D) Blood loss, decreased outflow resistance, and acid-base imbalance

Question 12

Which of the following IV solutions is recommended for treatment of prerenal failure?

A) Dextrose in water
B) Normal saline
C) Albumin
D) Lactated Ringer solution

Question 13

Which of the following laboratory values is the most help in evaluating a patient for acute renal failure?

A) Serum sodium
B) Serum creatinine
C) Serum potassium
D) Urine potassium

Question 14

A patient has been hospitalized for a subtotal gastrectomy.After the procedure,an infection developed that eventually had to be treated with gentamicin,an aminoglycoside antibiotic.After 3 days of administration,oliguria occurred,and subsequent laboratory values indicated elevated blood-urea-nitrogen and creatinine levels.The patient is transferred to the critical care unit with acute tubular necrosis.The patient is in the oliguric/anuric phase of acute tubular necrosis.Which statement best describes this phase?

A) It is the period of time from insult until cell injury. A decrease in glomerular filtration rate (GFR) results and disrupts the integrity of the tubular epithelium.
B) It is characterized by an increase in GFR in which the kidneys can clear volume and not solutes.
C) It is referred to as the maintenance phase and lasts 5 to 8 days in a nonoliguric patient and 10 to 16 days in an oliguric patient.
D) Renal function slowly returns to normal with a GFR at 70% to 80%.

Question 15

The most common site for short-term vascular access for immediate hemodialysis is the

A) subclavian artery.
B) subclavian vein.
C) femoral artery.
D) radial vein.

Question 16

To assess whether or not an arteriovenous fistula is functioning,what must be done and why?

A) Palpate the quality of the pulse distal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow.
B) Palpate the quality of the pulse proximal to the site to determine whether a thrill is present; auscultate with a stethoscope to appreciate a bruit to assess the quality of the blood flow.
C) Palpate gently over the site of the fistula to determine whether a thrill is present; listen with a stethoscope over this site to appreciate a bruit to assess the quality of the blood flow.
D) Palpate over the site of the fistula to determine whether a thrill is present; check whether the extremity is pink and warm.

Question 17

The patient is a gravida 6,para 1.She is admitted after a cesarean section after an amniotic embolus.Her heart rate (HR)is more than 150 beats/min with a systolic BP less than 80 mm Hg.Her temperature is 38°C,and her condition has caused her to develop prerenal azotemia.The patient was fluid resuscitated through a double-lumen catheter,which was placed into her right femoral access,and started on vasopressors with a fair response (BP,80/50 mm Hg; HR,122 beats/min).Because of her diagnosis and a concern regarding fulminating sepsis,the patient was begun on CVVH.Why would this therapy be chosen for this patient?

A) Hyperdynamic patients can better tolerate abrupt fluid and solute changes.
B) It is the treatment of choice for patients with diminished renal perfusion who are unresponsive to diuretics.
C) It is indicated for patients who require large-volume removal for severe uremia or critical acid-base imbalances.
D) It is indicated for hemodynamically unstable patients, who are often intolerant of the abrupt fluid and solute changes that can occur with hemodialysis.

Question 18

A patient has sepsis and is placed on broad-spectrum antibiotics.Her temperature is 37.8°C.Her BUN level is elevated.She continues on vasopressor therapy.What other steps should be taken to protect the patient from inadequate organ perfusion?

A) Increase net ultrafiltrate of fluid.
B) Discontinue vasopressor support.
C) Assess the patient for blood loss and hypotension.
D) Notify the physician of access pressures.

Question 19

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage.Which category of renal failure is the patient at the greatest risk of developing?

A) Intrinsic
B) Postrenal
C) Prerenal
D) Acute tubular necrosis

Question 20

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin.How do these agents lower potassium?

A) They force potassium out of the cells and into the serum, lowering it on a cellular level.
B) They promote higher excretion of potassium in the urine.
C) They bind with resin in the bowel and are eliminated in the feces.
D) They force potassium out of the serum and into the cells, thus causing potassium to lower.

Question 21

Laboratory results come back on a newly admitted patient.They are as follows: serum BUN,64 mg/dL; serum creatinine,2.4 mg/dL; urine osmolality,210 mOsm/kg; specific gravity,1.002; and urine sodium,96 mEq/L.The urine output has been 120 mL since admission 2 hours ago.These values are most consistent with which of the following diagnoses?

A) Prerenal failure
B) Postrenal failure
C) Oliguric renal failure
D) Acute tubular necrosis

Question 22

A patient with renal failure reports all of the following during the medical history.Which is most likely to have precipitated the patient's renal failure?

A) Recent computed tomography of the brain with and without contrast
B) A recent bout of congestive heart failure after an acute myocardial infarction
C) Twice-daily prescription of Lasix 40 mg by mouth
D) A recent bout of benign prostatic hypertrophy and transurethral resection of the prostate

Question 23

To prevent catheter-associated UTI (CAUTI),the nurse should

A) insert urinary catheters using aseptic techniques.
B) change the urinary catheter daily.
C) review the need for the urinary catheter daily and remove promptly.
D) flush the urinary catheter q8 hours to maintain patency.
E) avoid unnecessary use of indwelling urinary catheters.

Question 24

A patient with chronic renal failure receives hemodialysis treatments 3 days a week.Every 2 weeks,the patient requires a transfusion of 1 or 2 U of packed red blood cells.What is the probable reason for this patient's frequent transfusion needs?

A) Too much blood phlebotomized for tests
B) Increased destruction of red blood cells because of the increased toxin levels
C) Lack of production of erythropoietin to stimulate red blood cell formation
D) Fluid retention causing hemodilution

Question 25

An alert and oriented patient presents with a pulmonary artery wedge pressure of 4 mm Hg and a cardiac index of 0.8.The BUN is 44 mg/dL,creatinine is 3.2 mg/dL,and BP is 88/36 mm Hg.Urine output is 15 mL/hr.Lungs are clear to auscultation with no peripheral edema noted.Which of the following treatments would the physician most likely order?

A) Lasix 40 mg intravenous push
B) 0.9% normal saline at 125 mL/hr
C) Dopamine 15 ?g/kg/min
D) Transfuse 1 U of packed red blood cells

Question 26

Which of the following diuretics maybe combined to work on different parts of the nephron?

A) Loop and thiazide diuretics
B) Loop and osmotic diuretics
C) Osmotic and carbonic anhydrase inhibitor diuretics
D) Thiazide and osmotic diuretics

Question 27

Which of the following conditions is associated between kidney failure and respiratory failure?

A) ARDS
B) Lower GFR
C) Increased urine output
D) Decreased urine output
E) Decreased blood flow to the kidneys

Question 28

A patient in acute renal failure presents with a potassium level of 6.9 mg/dL.He has had no urine output in the past 4 hours despite urinary catheter insertion and Lasix 40 mg intravenous push.Vital signs are as follows: HR,76 beats/min; respiratory rate,18 breaths/min; and BP,145/96 mm Hg.He is given 100 mL of 50% dextrose in water and 20 U of regular insulin intravenous push.A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL.What order would now be expected?

A) Sodium Kayexalate 15 g PO
B) Nothing; this represents a normal potassium level
C) Lasix 40 mg IVP
D) 0.9% normal saline at 125 mL/hr

Question 29

Which of the following medications is considered a loop diuretic?

A) Acetazolamide (Diamox)
B) Furosemide (Lasix)
C) Mannitol
D) Metolazone (Zaroxolyn)

Question 30

What is the dose for low-dose dopamine?

A) 1 to 2 mcg/kg/min
B) 1 to 2 mg/kg/min
C) 2 to 3 mcg/kg/min
D) 2 to 3 mg/kg/min