Question 1

A patient with acute kidney injury (AKI)has longer QRS intervals on the electrocardiogram (ECG)than were noted on the previous shift.Which action should the nurse take first?

Accepted Answer

The increasing QRS interval is suggestive of hyperkalemia,so the nurse should check the most recent potassium and then notify the patient's health care provider.The BUN and creatinine will be elevated in a patient with AKI,but they would not directly affect the electrocardiogram (ECG).Documentation of the QRS interval is also appropriate,but interventions to decrease the potassium level are needed to prevent life-threatening dysrhythmias.

Question 2

A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI)caused by dehydration.Which information will be most important for the nurse to report to the health care provider?

Accepted Answer

The high urine output indicates a need to increase fluid intake to prevent hypovolemia.The other information is typical of AKI and will not require a change in therapy.

Question 3

A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria,anemia,and hyperkalemia.Which prescribed actions should the nurse take first?

Accepted Answer

Because hyperkalemia can cause fatal cardiac dysrhythmias,the initial action should be to monitor the cardiac rhythm.Kayexalate and Epogen will take time to correct the hyperkalemia and anemia.The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.

Question 4

A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease.Which observation by the RN requires an intervention?

Accepted Answer

Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed.The phosphate binder should be given with a meal and the iron given at a different time.The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency.

Question 5

A 55-year-old patient with end-stage kidney disease (ESKD)is scheduled to receive a prescribed dose of epoetin alfa (Procrit).Which information should the nurse report to the health care provider before giving the medication?

Accepted Answer

High hemoglobin levels are associated with a higher rate of thromboembolic events and increased risk of death from serious cardiovascular events (heart attack,heart failure,stroke)when erythropoietin (EPO)is administered to a target hemoglobin of >12 g/dL.Hemoglobin levels higher than 12 g/dL indicate a need for a decrease in epoetin alfa dose.The other information also will be reported to the health care provider but will not affect whether the medication is administered.

Question 6

After receiving change-of-shift report,which patient should the nurse assess first?

Accepted Answer

The patient who is tachycardic after hemodialysis may be bleeding or excessively hypovolemic and should be assessed immediately for these complications.The other patients also need assessments or interventions but are not at risk for life-threatening complications.

Question 7

The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation.Which parameter will be most important for the nurse to consider?

Accepted Answer

Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour.The other data will be monitored but are not the most important determinants of fluid infusion rate.

Question 8

A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident.Which laboratory result will be most important to report to the health care provider?

Accepted Answer

The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately.The nurse also will report the other laboratory values,but abnormalities in these are not immediately life threatening.

Question 9

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis ?

Accepted Answer

Patients who are receiving peritoneal dialysis should have a high-protein diet.Phosphate binders are taken with meals to help control serum phosphate and calcium levels.Commercial salt substitutes are high in potassium and should be avoided.Fluid intake is limited in patients requiring dialysis.Dairy products are high in phosphate and usually are limited.

Question 10

A female patient with chronic kidney disease (CKD)is receiving peritoneal dialysis with 2 L inflows.Which information should the nurse report immediately to the health care provider?

Accepted Answer

Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started.The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

Question 11

A 72-year-old patient with a history of benign prostatic hyperplasia (BPH)is admitted with acute urinary retention and elevated blood urea nitrogen (BUN)and creatinine levels.Which prescribed therapy should the nurse implement first?

Accepted Answer

The patient's elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention,so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient.The other actions also are appropriate,but should be implemented after the retention catheter.

Question 12

Which intervention will be included in the plan of care for a male patient with acute kidney injury (AKI)who has a temporary vascular access catheter in the left femoral vein?

Accepted Answer

The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein.Protein intake is likely to be increased when the patient is receiving dialysis.The retention catheter is likely to remain in place because accurate measurement of output will be needed.There is no indication that the patient needs continuous pulse oximetry.

Question 13

During routine hemodialysis,the 68-year-old patient complains of nausea and dizziness.Which action should the nurse take first?

Accepted Answer

The patient's complaints of nausea and dizziness suggest hypotension,so the initial action should be to check the BP.The other actions may also be appropriate based on the blood pressure obtained.

Question 14

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin)60 mg IV BID.The nurse will monitor for adverse effects of the medication by evaluating the patient's

Accepted Answer

When a patient at risk for chronic kidney disease (CKD)receives a potentially nephrotoxic medication,it is important to monitor renal function with BUN and creatinine levels.The other laboratory values would not be useful in assessing for the adverse effects of the gentamicin.

Question 15

The nurse is assessing a patient 4 hours after a kidney transplant.Which information is most important to communicate to the health care provider?

Accepted Answer

The decrease in CVP suggests hypovolemia,which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis.The other information is not unusual in a patient after a transplant.

Question 16

A patient in the oliguric phase after an acute kidney injury has had a 250 mL urine output and an emesis of 100 mL in the past 24 hours.What is the patient's fluid restriction for the next 24 hours?

Accepted Answer

The answer of A patient in the oliguric phase after...

Question 17

A 74-year-old who is progressing to stage 5 chronic kidney disease asks the nurse,"Do you think I should go on dialysis? Which initial response by the nurse is best?

Accepted Answer

The nurse should initially clarify the patient's concerns and questions about dialysis.The patient is the one responsible for the decision and many people using dialysis do have good quality of life,but these responses block further assessment of the patient's concerns.Referring to which type of dialysis the patient might use only indirectly responds to the patient's question.

Question 18

A patient has arrived for a scheduled hemodialysis session.Which nursing action is most appropriate for the registered nurse (RN)to delegate to a dialysis technician?

Accepted Answer

Dialysis technicians are educated in monitoring for blood pressure.Assessment,adjustment of the appropriate ultrafiltration rate,and patient teaching require the education and scope of practice of an RN.

Question 19

A patient complains of leg cramps during hemodialysis.The nurse should first

Accepted Answer

Muscle cramps during dialysis are caused by rapid removal of sodium and water.Treatment includes infusion of normal saline.The other actions do not address the reason for the cramps.

Quiz 47: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease

A patient with acute kidney injury (AKI) has longer QRS intervals on the electrocardiogram (ECG) than were noted on the previous shift.Which action should the nurse take first?

A 62-year-old female patient has been hospitalized for 8 days with acute kidney injury (AKI) caused by dehydration.Which information will be most important for the nurse to report to the health care provider?

A 42-year-old patient admitted with acute kidney injury due to dehydration has oliguria,anemia,and hyperkalemia.Which prescribed actions should the nurse take first?

A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease.Which observation by the RN requires an intervention?

A 55-year-old patient with end-stage kidney disease (ESKD) is scheduled to receive a prescribed dose of epoetin alfa (Procrit) .Which information should the nurse report to the health care provider before giving the medication?

After receiving change-of-shift report,which patient should the nurse assess first?

The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation.Which parameter will be most important for the nurse to consider?

A 25-year-old male patient has been admitted with a severe crushing injury after an industrial accident.Which laboratory result will be most important to report to the health care provider?

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis ?

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2 L inflows.Which information should the nurse report immediately to the health care provider?

A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels.Which prescribed therapy should the nurse implement first?

Which intervention will be included in the plan of care for a male patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?

During routine hemodialysis,the 68-year-old patient complains of nausea and dizziness.Which action should the nurse take first?

A patient with diabetes who has bacterial pneumonia is being treated with IV gentamicin (Garamycin) 60 mg IV BID.The nurse will monitor for adverse effects of the medication by evaluating the patient's

The nurse is assessing a patient 4 hours after a kidney transplant.Which information is most important to communicate to the health care provider?

A patient in the oliguric phase after an acute kidney injury has had a 250 mL urine output and an emesis of 100 mL in the past 24 hours.What is the patient's fluid restriction for the next 24 hours?

A 74-year-old who is progressing to stage 5 chronic kidney disease asks the nurse,"Do you think I should go on dialysis? Which initial response by the nurse is best?

A patient has arrived for a scheduled hemodialysis session.Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician?

A patient complains of leg cramps during hemodialysis.The nurse should first