Deck 15: Care of the Patient With Acute Kidney Injury

Question 1

While reviewing a patient's medication record, the critical care nurse should be concerned about which drugs that have been implicated in the development of renal failure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Cyclosporine
2) Contrast media
3) Aminoglycosides
4) Antiseizure medications
5) Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer 1

1, 2, 3, 5
Explanation: 1. Cyclosporine has been implicated in the development of renal failure.
2. Contrast media have been implicated in the development of renal failure.
3. Aminoglycosides have been implicated in the development of renal failure.
4. Antiseizure medications are not nephrotoxic.
5. NSAIDs have been implicated in the development of renal failure.

Question 2

Which diet should the nurse anticipate being prescribed for a patient with an acute kidney injury?
1) High fat, low protein
2) High carbohydrate, low protein
3) High protein, low sodium
4) High calorie, low carbohydrate

Answer 2

2
Explanation: 1. A high-fat diet is not healthy for any patient population. A low-protein diet is not appropriate as this would cause the body to break down lean muscle mass for metabolic function.
2. Goals for nutritional intervention in the patient with acute kidney injury include preserving lean body mass, preventing metabolic alterations, and enhancing renal recovery by limiting uremic toxicity. Protein is allowed but limited because its catabolism may result in accumulation of toxic waste products (urea, phosphate, and potassium). Protein requirements can be calculated roughly based on the rise in the patient's BUN in 24 hours, and the amount of protein in the patient's diet can be based on this calculation. The remainder of the calories the patient requires is supplied as carbohydrates or lipids.
3. A high-protein diet is not appropriate as this would cause a lethal amount of toxic waste to accumulate in a renal failure patient. A low-sodium diet would be appropriate as this would aid in reducing fluid retention.
4. A high-caloric diet is not appropriate as this would contribute to unnecessary weight gain. Carbohydrates are needed for energy, so restriction would be detrimental.

Question 3

Of the following patients in an intensive care unit, which patient should the nurse identify as being at highest risk for the development of acute kidney injury with a prerenal cause?
1) Experiencing acute status asthmaticus
2) Being treated for hypertension following a cerebral vascular accident
3) In skeletal traction following a motor vehicle accident
4) Postoperative from a ruptured abdominal aortic aneurysm

Answer 3

4
Explanation: 1. Status asthmaticus is a severe airway obstruction that results in respiratory acidosis. There is not an associated reduction in cardiac output linked with this problem.
2. Hypertension is associated with the development of chronic renal failure and end-stage renal disease.
3. Long bone fractures can result in blood loss, but the amount of blood lost is less than what would be considered as a prerenal cause for acute kidney injury.
4. Prerenal failure commonly results from a pronounced reduction in cardiac output due to severe hypotension, hypovolemia, or severe vasoconstriction. The patient who has experienced significant blood loss, as in a ruptured aortic aneurysm, would be at greatest risk for the development of acute kidney injury with a prerenal cause.

Question 4

Which of the following should the intensive care nurse explain to a patient with acute kidney injury is the most effective method for reducing hyperkalemia?
1) Insulin plus glucose
2) Inhaled beta agonists
3) Sodium bicarbonate
4) Hemodialysis

Question 5

What would be the best nutritional goal for the patient with acute kidney injury?
1) Weight will increase by 3 pounds in a month.
2) Patient eats over 50% of all meals.
3) Albumin level will rise from 2.6 g/dL.
4) Total protein level will increase to 10 g/dL.

Question 6

For which order should the nurse seek clarification regarding a patient with decreased renal perfusion and lowered glomerular filtration rate?
1) Administer acetylcysteine prior to an intravenous pyelogram procedure.
2) Infuse vancomycin 1,500 mg IV every 12 hours.
3) Check a peak and trough level with every third dose of IV clindamycin.
4) Give furosemide 10 mg by mouth daily.

Question 7

A patient in the intensive care unit is reported to be in the oliguric phase of intrinsic renal failure. What assessment finding supports this clinical determination?
1) Urine output of less then 400 mL/day
2) BUN and creatinine that may begin to increase slightly
3) Urinary output of up to 5 liters of urine each day
4) Abnormal laboratory values that can last from 6 months to a year in duration

Question 8

The nurse believes a patient is experiencing prerenal dysfunction and not intrinsic renal failure because of which laboratory finding?
1) Urine osmolality of 200 mOsm/L
2) Urine osmolality of 550 mOsm/L
3) Urine sodium greater than 40 mmol/L
4) Presence of granular casts and sediment

Question 9

The nurse reviews a critically ill patient's history for which cause of intrinsic renal failure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Contrast media given intravenously during diagnostic imaging
2) Prescribed levothyroxine (Synthroid) following thyroidectomy
3) Acyclovir (Zovorax) prescribed for treatment of genital herpes
4) Receiving prophylactic chemotherapy after surgery for cancer
5) History of using high-dose NSAIDs for rheumatoid arthritis

Question 10

To test for a positive Trousseau's sign indicating hypocalcemia, the nurse should use which piece of equipment?
1) Percussion hammer
2) Penlight
3) Blood pressure cuff
4) Doppler

Question 11

What should the critical care nurse expect to assess to determine if a fluid challenge provided to an 80-year-old patient had the intended effect?
1) A systolic blood pressure of 120 mm Hg or less
2) Heart rate remaining steady at 60 to 70 beats per minute
3) Skin turgor showing improvement within 24 hours
4) A MAP of 70 mm Hg or higher

Question 12

Using evidence-based practice interventions for a patient with acute kidney injury, what should the nurse identify as being the best approach for fluid volume excess management?
1) A sodium-restricted diet
2) Diuretics
3) Fluid restriction
4) Plasmapheresis

Question 13

A patient with acute kidney injury is disappointed that hemodialysis, instead of peritoneal dialysis, is planned for treatment. After teaching about the two types of dialysis, the nurse determines that further instruction is needed when the patient makes which statement about the disadvantages of peritoneal dialysis?
1) "It's not speedy enough to remove the wastes."
2) "It may worsen my breathing problems."
3) "It cannot be used for older patients like me."
4) "It's not nearly as efficient as hemodialysis."

Question 14

What is the most common complication that the nurse should assess in a patient undergoing intermittent hemodialysis (IHD)?
1) Hypotension
2) Infection
3) Hyperglycemia
4) Hypokalemia

Question 15

A nurse plans to administer to a patient a fluid challenge for the purpose of establishing normal renal perfusion. What does this treatment involve?
1) Infusing 250 mL of 0.9% sodium chloride over 1 hour
2) Administering albumin intravenously, followed by furosemide
3) Infusing 500 mL of normal saline over a 30-minute period
4) Giving twice the amount of IV fluid each hour compared to urinary output

Question 16

What should the nurse do when caring for a patient with an arteriovenous (AV) fistula in the forearm for hemodialysis?
1) Percuss the fistula for presence of a bruit each shift
2) Take the blood pressure in the unaffected arm
3) Position the patient so there is pressure on the access area
4) Flush the fistula with heparin every shift

Question 17

What should the nurse identify as the most accurate indicator of fluid volume status?
1) Intake and output
2) Daily weights
3) Hematocrit level
4) Systolic blood pressure

Question 18

A patient has been placed on a 1,000-mL fluid restriction over 24 hours. Which plan should the nurse choose to divide this fluid?
1) 350 mL for dayshift, 325 mL for evening shift, and 325 mL for nightshift
2) 400 mL for dayshift, 400 mL for evening shift, and 200 mL for nightshift
3) 500 mL for dayshift, 325 mL for evening shift, and 125 mL for nightshift
4) 600 mL for dayshift, 200 mL for evening shift, and 200 mL for nightshift

Question 19

Which patient situation would increase the risk for developing dialysis disequilibrium syndrome?
1) Peritoneal dialysis provided in a home environment
2) Patient who received an ACE inhibitor prior to hemodialysis
3) A known history of long-term substance abuse
4) Patient undergoing first hemodialysis treatment

Question 20

A patient is experiencing prerenal failure secondary to hypovolemia. The nurse reviewing the patient's laboratory work and vascular pressures should expect to see which results? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Creatinine clearance of 50 mL/min/1.73m²
2) Low CVP or PAWP pressures
3) BUN of 65 mg/dL
4) Serum creatinine of 3 mg/dL
5) Urine with granular casts and sediment

Question 21

A patient with an acute kidney injury is prescribed intravenous calcium for a calcium level of 6.8 mEq/L. What action should the nurse take when providing this medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Administer the medication IV push over 2 minutes.
2) Observe for electrocardiogram rhythm changes in 1 to 3 minutes after administering the medication.
3) Monitor for ongoing effects to last 30 to 60 minutes.
4) Discontinue the medication if tachycardia occurs.
5) Observe for a urine output increase within 10 minutes after administering this medication.

Question 22

The nurse identifies that a patient is at risk for the development of postrenal acute kidney injury. What information did the nurse use to make this clinical determination? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) The patient is prescribed diuretics for hypertension.
2) The patient restricts the intake of dairy products.
3) The patient takes phenytoin for a seizure disorder.
4) The patient was treated for renal calculi twice over the last 4 months.
5) The patient was diagnosed with benign prostatic hypertrophy 6 months ago.

Question 23

A patient with acute kidney injury has a serum sodium level of 116 mEq/L. What should the nurse expect to assess in this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Seizures
2) Hostility
3) Lethargy
4) Headache
5) Disorientation

Question 24

The nurse prepares an infusion of norepinephrine for a patient with acute kidney injury. What are the nurse's responsibilities when providing this medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Monitor the blood pressure every 2 to 5 minutes.
2) Monitor changes in MAP.
3) Monitor heart rate and pattern.
4) Infuse through the central line.
5) Infuse through a hand vein.

Question 25

A patient with prerenal acute kidney injury has a blood pressure of 78/50 mm Hg. Which medication should the nurse anticipate being prescribed for this patient?
1) Dopamine
2) Calcium citrate
3) Norepinephrine
4) Calcium gluconate

Question 26

Why should the nurse suspect that a patient with acute kidney injury will not be prescribed peritoneal dialysis? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Peritoneal dialysis takes too much time to remove body wastes.
2) The excess fluid in the peritoneum can negatively impact the patient's breathing.
3) There are poorer outcomes from using peritoneal dialysis.
4) The patient has hypertension.
5) The patient has a potassium level of 5.5 mEq/L.

Question 27

A patient with acute kidney injury is prescribed intermittent hemodialysis three times a week for 4 hours each session. The nurse should plan interventions to address what problem that can occur between sessions? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Fluid overload
2) Waste accumulation
3) Electrolyte imbalances
4) Hypotension
5) Infection

Question 28

The nurse prepares information about kidney disease for a group of new graduates. What should the nurse include about the function of the kidneys? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) The kidneys clear body wastes.
2) The kidneys produce active vitamin D.
3) The kidneys isolate infectious processes.
4) The kidneys stimulate production of red blood cells.
5) The kidneys assist with regulation of blood pressure.

Question 29

A critically ill patient is being evaluated for acute kidney injury. The nurse should expect which laboratory test to be prescribed for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Urinalysis
2) Blood-urea-nitrogen level
3) Serum creatinine
4) Arterial blood gases
5) Hemoglobin and hematocrit levels

Question 30

The nurse adds interventions to address renal replacement therapy for a patient with acute kidney injury. What assessment finding did the nurse use to make this alteration in the patient's care plan? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) New onset of pruritus
2) Asking for medication for pain
3) Blood pressure 190/110 mm Hg
4) Refusing to eat breakfast and lunch
5) Experiencing muscle cramps in the calves

Question 31

The nurse plans care for a patient with an acute kidney injury. Which intervention should prevent further injury to the patient's kidneys? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Use strict aseptic technique when providing care.
2) Discuss the need for acetylcysteine with the health care provider prior to testing that uses contrast dye.
3) Measure urine output every 8 hours.
4) Prepare a fluid challenge with dextrose 5% and water.
5) Calculate fluid restriction.

Question 32

The nurse cares for a patient during continuous renal replacement therapy. What intervention should the nurse perform at this time? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Monitor vital signs every half hour.
2) Administer replacement fluid as determined by the hourly fluid balance goal.
3) Assess partial thromboplastin time every 1 to 2 hours.
4) Warm the dialysate to body temperature.
5) Inspect the dialysate return.

Question 33

The nurse preparing to administer peritoneal dialysis would have which responsibility in contrast to hemodialysis?
1) Knowing the patient's dry weight prior to beginning
2) Monitoring for changes in vital signs
3) Inspecting the tunneled catheter for infection
4) Suggesting a low-Fowler's position for comfort

Question 34

The nurse should identify which nursing diagnosis for the patient experiencing dialysis disequilibrium syndrome?
1) Infection
2) Altered thought processes
3) Fluid volume deficit
4) Anxiety

Question 35

The critical care nurse provides a training session on the principles of renal replacement therapies. When discussing how solutes move across a semipermeable membrane from a higher to lower concentration, what is the nurse describing?
1) Ultrafiltration
2) Diffusion
3) Active transport
4) Osmosis

Question 36

To assist with the common complication of hypotension for the patient undergoing continuous renal replacement therapy, the nurse should implement which action? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Infuse 0.9% sodium chloride boluses.
2) Administer mannitol.
3) Decrease the rate of ultrafiltration on the dialyzer.
4) Administer albumin.
5) Place the patient in a high-Fowler's position.

Question 37

The nurse calculates the distribution of restricted fluids for a patient with acute kidney injury. The patient had a urine output of 200 mL the previous day. What amount of fluid is the patient permitted during the night? Record your answer, rounding to the nearest whole number.

Question 38

The nurse notes that a patient receiving peritoneal dialysis has a dialysate return deficit of 300 mL. What action should the nurse take at this time? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Change the cycler.
2) Examine the tubing for kinks.
3) Hand flush the dialysis catheter.
4) Infuse 500 mL additional dialysate.
5) Assist the patient to change position.