Deck 26: Kidney Disorders and Therapeutic Management

Question 1

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

A) Subclavian artery
B) Subclavian vein
C) Femoral artery
D) Radial vein

Answer 1

Subclavian vein

Question 2

A patient who receives peritoneal dialysis is admitted after a 3-day history of flulike symptoms.The patient reports muscle cramps and is noted to have a low blood pressure and tachycardia.The nurse suspects the patient may be experiencing what condition?

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

Answer 2

Dehydration

Question 3

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.What is this process called?

A) Ultrafiltration
B) Hemodialysis
C) Reverse osmosis
D) Colloid extraction

Answer 3

Ultrafiltration

Question 4

A patient is admitted with sepsis and acute kidney injury (AKI).The patient is started on continuous renal replacement therapy (CRRT).The nurse knows that fluid that is removed each hour is charted as what on the CRRT flowsheet?

A) Convection
B) Diffusion
C) Replacement fluid
D) Ultrafiltrate

Question 5

A patient has developed acute kidney injury (AKI)secondary to cardiogenic shock.Which laboratory value would the nurse find helpful in evaluating patient's renal status?

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

Question 6

The practitioner has ordered dialysis for a patient with acute heart failure who is unresponsive to diuretics.Which type of dialysis would the nurse anticipate being started on this patient?

A) Intermittent ultrafiltration
B) Continuous venovenous hemofiltration (CVVH)
C) Continuous venovenous hemodialysis (CVVHD)
D) Continuous venovenous hemodiafiltration (CVVHDF)

Question 7

One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin.Which statement regarding how this treatment works is accurate?

A) Glucose and insulin force potassium out of the cells, lowering it on a cellular level.
B) Glucose and insulin promote higher excretion of potassium in the urine.
C) Glucose and insulin bind with potassium, lowering available amounts.
D) Glucose and insulin force potassium into the cells, lowering it on a serum level.

Question 8

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodialysis (CVVHD).The nurse understands that this type of continuous renal replacement therapy (CRRT)is indicated for the patient who needs what type of treatment?

A) Fluid removal only
B) Fluid removal and moderate solute removal
C) Fluid removal and maximum solute removal
D) Maximum fluid and solute removal

Question 9

A patient was admitted with an infection that had to be treated with gentamicin,an aminoglycoside antibiotic.After 3 days of administration,the patient developed oliguria,and an elevated blood urea nitrogen and creatinine levels.The nurse suspects the patient has developed what type of kidney injury?

A) Prerenal
B) Intrarenal
C) Anuric
D) Postrenal

Question 10

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodialysis (CVVHD).The nurse knows the hemodialyzer filter used in this type of therapy is permeable to what substance?

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

Question 11

What is the recommended nutritional intake of protein to control azotemia in the patient with acute kidney injury?

A) 0.5 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 12

A patient was admitted with an infection that had to be treated with an aminoglycoside antibiotic.After a few days the patient developed oliguria and elevated blood urea nitrogen and creatinine levels.The patient's vital signs are stable.The nurse would anticipate the practitioner ordering which dialysis method for this patient?

A) Peritoneal dialysis
B) Hemodialysis
C) Continuous renal replacement therapy
D) Intermittent ultrafiltration

Question 13

A patient has developed acute kidney injury (AKI)secondary to hemorrhage shock.Which intravenous solution would the nurse expect to be ordered for this patient?

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

Question 14

To assess whether or not an arteriovenous fistula is functioning,what must the nurse do 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 15

A patient with chronic kidney disease was admitted with severe electrolyte disturbances.The patient had been ill and missed several hemodialysis sessions.The patient is disoriented,dizzy,cold,clammy,and complains of severe abdominal cramping.The patient's electrocardiogram appears normal.Which electrolyte disturbance would the nurse suspect the patient may be experiencing?

A) Hyponatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypochloremia

Question 16

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodialysis (CVVHD).The nurse understands the patient should be closely monitored for what patient-related complications of the therapy?

A) Air embolism, access failure, and blood leaks
B) Decreased inflow pressure, air bubbles, and power surge
C) Infection, hypotension, and electrolyte imbalances
D) Catheter dislodgement, decreased outflow pressure, and acid-base imbalances

Question 17

An elderly patient is in a motor vehicle accident and sustains a significant internal hemorrhage.The nurse knows the patient is at risk for developing what type of acute kidney injury (AKI)?

A) Intrinsic
B) Postrenal
C) Prerenal
D) Intrarenal

Question 18

A patient was admitted with liver failure and acute kidney injury (AKI).Which intravenous solution should the nurse question if it were ordered for this patient?

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

Question 19

The practitioner has ordered continuous renal replacement therapy (CRRT)for a patient with acute kidney injury.The patient needs both the removal of fluids and a moderate amount of solutes.Which type of CRRT would the nurse anticipate being started on this patient?

A) Slow continuous ultrafiltration (SCUF)
B) Continuous venovenous hemofiltration (CVVH)
C) Continuous venovenous hemodialysis (CVVHD)
D) Continuous venovenous hemodiafiltration (CVVHDF)

Question 20

A patient with acute kidney injury (AKI)has been started on continuous venovenous hemodiafiltration (CVVHDF).The nurse understands the patient should be closely monitored for what circuit-related complications of the therapy?

A) Hypervolemia, hypothermia, and hyperkalemia
B) Access dislodgment, decreased outflow pressures, and bleeding
C) Filter clotting, access failure, and air embolism
D) Increased overflow pressure, dehydration, and calcium loss

Question 21

A patient with chronic kidney disease 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) Hemodilution secondary to fluid retention

Question 22

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

Question 23

Which 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 24

A patient is admitted with acute kidney injury (AKI).Which event from the patient's history was the most probable cause of the patient's AKI?

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

Question 25

An alert and oriented patient presents with a pulmonary artery occlusion pressure (PAOP)of 4 mm Hg,blood pressure of 88/50 mm Hg,cardiac index of 1.8,and urine output of 15 mL/h.The patient's blood urea nitrogen (BUN)is 44 mg/dL and creatinine is 3.2 mg/dL.Lungs are clear to auscultation with no peripheral edema noted.Which treatment would the nurse expect the practitioner to order?

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

Question 26

A patient is admitted with respiratory failure and is being mechanically ventilated.The nurse understands there is a significant association between acute kidney injury and respiratory failure.How does mechanical ventilation alter kidney function?

A) Decreases blood flow to the kidney
B) Decreases glomerular filtration rate (GFR)
C) Damages the kidney tubular endothelium
D) Decreases urine output
E) Hinders flow of urine from the kidneys

Question 27

The nursing management plan for the patient with a urinary drainage catheter would include which interventions to prevent catheter-associated urinary tract infection (CAUTI)?

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 28

Laboratory results come back on a newly admitted patient: Serum blood urea nitrogen,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 patient's urine output has been 120 mL since admission 2 hours ago.These values are most consistent with which diagnosis?

A) Prerenal acute kidney injury
B) Postrenal acute kidney injury
C) Oliguric acute kidney injury
D) Intrarenal acute kidney injury

Question 29

A patient with acute kidney injury has a potassium level of 6.9 mg/dL.The patient has had no urine output in the past 4 hours despite administration of Lasix 40 mg intravenous push.To correct the hyperkalemia the patient is given 50 mL of 50% dextrose in water and 10 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 the nurse expect now?

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/h

Question 30

Which medication is classified as a loop diuretic?

A) Acetazolamide
B) Furosemide
C) Mannitol
D) Metolazone