NP3 Exam 1 with verified !| !| !| !| !|
solutions & rationales !| !|
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
injury (AKI). Which condition would the nurse expect to find in the patient's
!| !| !| !| !| !| !| !| !| !| !| !| !|
recent history? !|
a. Pyelonephritis
!|
b. Dehydration
!|
c. Bladder cancer
!| !|
d. Kidney stones - Correct answer ✔ANS: B
!| !| !| !| !| !| !|
Prerenal causes of AKI are related to a decrease in perfusion, such as in
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
clients who have prolonged dehydration. Pyelonephritis is an intrinsic or
!| !| !| !| !| !| !| !| !| !|
intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney
!| !| !| !| !| !| !| !| !| !| !| !|
stones are postrenal causes of AKI related to urine flow obstruction.
!| !| !| !| !| !| !| !| !| !|
2. A marathon runner comes into the clinic and states "I have not urinated
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
very much in the last few days." The nurse notes a heart rate of 110 beats/min
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
and a blood pressure of 86/58 mm Hg. Which action by the nurse is most
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
appropriate?
a. Give the client a bottle of water immediately.
!| !| !| !| !| !| !| !|
b. Start an intravenous line for fluids.
!| !| !| !| !| !|
c. Teach the patient to drink 2 to 3 L of water daily.
!| !| !| !| !| !| !| !| !| !| !| !|
d. Perform an electrocardiogram. - Correct answer ✔ANS: A
!| !| !| !| !| !| !| !|
,This athlete is mildly dehydrated as evidenced by the higher heart rate and
!| !| !| !| !| !| !| !| !| !| !| !| !|
lower blood pressure. The nurse can start hydrating the client with a bottle
!| !| !| !| !| !| !| !| !| !| !| !| !|
of water first, followed by teaching the patient to drink 2 to 3 L of water each
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
day. An intravenous line may be needed later, after the patient's degree of
!| !| !| !| !| !| !| !| !| !| !| !| !|
dehydration is assessed. An electrocardiogram is not necessary at this time.
!| !| !| !| !| !| !| !| !| !|
3. A client comes into the emergency department with a serum creatinine of
!| !| !| !| !| !| !| !| !| !| !| !| !|
2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL
!| !| !| !| !| !| !| !| !| !| !| !| !|
(8.57 mmol/L). What question would the nurse ask first when taking this
!| !| !| !| !| !| !| !| !| !| !| !|
client's history? !|
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
!| !| !| !| !| !| !| !| !| !|
b. "Do you have anyone in your family with renal failure?"
!| !| !| !| !| !| !| !| !| !|
c. "Have you had a diet that is low in protein recently?"
!| !| !| !| !| !| !| !| !| !| !|
d. "Has a relative had a kidney transplant lately?" - Correct answer ✔ANS: A
!| !| !| !| !| !| !| !| !| !| !| !| !|
There are some medications that are nephrotoxic, such as the nonsteroidal
!| !| !| !| !| !| !| !| !| !| !|
anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a !| !| !| !| !| !| !| !| !| !|
good question to initially ask the patient since both the serum creatinine and
!| !| !| !| !| !| !| !| !| !| !| !| !|
BUN are elevated, indicating some renal problems. A diet high in protein
!| !| !| !| !| !| !| !| !| !| !| !|
could be a factor in an increased BUN.
!| !| !| !| !| !| !|
4. A client is admitted with acute kidney injury (AKI) and a urine output of
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
2000 mL/day. What is the major concern of the nurse regarding this patient's
!| !| !| !| !| !| !| !| !| !| !| !| !|
care?
a. Edema and pain
!| !| !|
b. Cardiac and respiratory status
!| !| !| !|
c. Electrolyte and fluid imbalance
!| !| !| !|
d. Mental health status - Correct answer ✔ANS: C
!| !| !| !| !| !| !| !|
,This client may have an inflammatory cause of AKI with proteins entering
!| !| !| !| !| !| !| !| !| !| !| !|
the glomerulus and holding the fluid in the filtrate, causing polyuria.
!| !| !| !| !| !| !| !| !| !| !|
Electrolyte loss and fluid balance are essential. Edema and pain are not !| !| !| !| !| !| !| !| !| !| !| !|
usually a problem with fluid loss. There could be changes in the client's
!| !| !| !| !| !| !| !| !| !| !| !| !|
cardiac, respiratory, and mental health status if the electrolyte imbalance is
!| !| !| !| !| !| !| !| !| !| !|
not treated.!|
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
Hg. The primary health care provider prescribed 1000 mL of normal saline to
!| !| !| !| !| !| !| !| !| !| !| !| !|
be infused over 1 hour to maintain perfusion. The client starts to develop
!| !| !| !| !| !| !| !| !| !| !| !| !|
shortness of breath. What is the nurse's priority action? !| !| !| !| !| !| !| !|
a. Calculate the mean arterial pressure (MAP).
!| !| !| !| !| !|
b. Ask for insertion of a pulmonary artery catheter.
!| !| !| !| !| !| !| !|
c. Take the client's pulse.
!| !| !| !|
d. Decrease the rate of the IV infusion. - Correct answer ✔ANS: D
!| !| !| !| !| !| !| !| !| !| !| !|
The nurse would assess that the client could be developing fluid overload
!| !| !| !| !| !| !| !| !| !| !| !|
and respiratory distress and slow down the normal saline infusion. The
!| !| !| !| !| !| !| !| !| !| !|
calculation of the MAP also reflects perfusion. The insertion of a pulmonary !| !| !| !| !| !| !| !| !| !| !| !|
artery catheter would evaluate the client's hemodynamic status, but this
!| !| !| !| !| !| !| !| !| !|
would not be the initial or priority action by the nurse. Vital signs are also
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
important after adjusting the intravenous infusion. !| !| !| !| !|
6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350
!| !| !| !| !| !| !| !| !| !| !| !| !|
mL/day. What is the best action by the nurse? !| !| !| !| !| !| !| !|
a. Place the client on a cardiac monitor immediately.
!| !| !| !| !| !| !| !|
b. Teach the client to limit high-potassium foods.
!| !| !| !| !| !| !|
, c. Continue to monitor the client's intake and output.
!| !| !| !| !| !| !| !|
d. Ask to have the laboratory redraw the blood specimen. - Correct answer
!| !| !| !| !| !| !| !| !| !| !| !| !|
✔ANS: A !|
The best action by the nurse would be to check the cardiac status with a
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
monitor. High-potassium levels can lead to dysrhythmias. The other choices
!| !| !| !| !| !| !| !| !| !|
are logical nursing interventions for acute kidney injury but not the best
!| !| !| !| !| !| !| !| !| !| !| !|
immediate action. !|
7. A client with diabetes mellitus type 2 has been well controlled with
!| !| !| !| !| !| !| !| !| !| !| !| !|
metformin. The client is scheduled for magnetic resonance imaging (MRI)
!| !| !| !| !| !| !| !| !| !|
scan with contrast. What priority would the nurse take at this time?
!| !| !| !| !| !| !| !| !| !| !|
a. Teach the client about the purpose of the MRI.
!| !| !| !| !| !| !| !| !|
b. Assess the client's blood urea nitrogen and creatinine.
!| !| !| !| !| !| !| !|
c. Tell the client to withhold metformin for 24 hours before the MRI.
!| !| !| !| !| !| !| !| !| !| !| !|
d. Ask the client if he or she is taking antibiotics. - Correct answer ✔ANS: C
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin
!| !| !| !| !| !| !| !| !| !|
can also be nephrotoxic and the client should not be exposed to two agents.
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
Clients who have diabetes are already at risk for renal damage.
!| !| !| !| !| !| !| !| !| !|
8. A client is started on continuous venovenous hemofiltration (CVVH).
!| !| !| !| !| !| !| !| !| !|
Which finding would require immediate action by the nurse?
!| !| !| !| !| !| !| !|
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
!| !| !| !| !| !| !|
b. Sodium level of 138 mEq/L (138 mmol/L)
!| !| !| !| !| !| !|
c. Blood pressure of 76/58 mm Hg
!| !| !| !| !| !|
d. Pulse rate of 88 beats/min - Correct answer ✔ANS: C
!| !| !| !| !| !| !| !| !| !|
solutions & rationales !| !|
1. The nurse is assessing a client with a diagnosis of prerenal acute kidney
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
injury (AKI). Which condition would the nurse expect to find in the patient's
!| !| !| !| !| !| !| !| !| !| !| !| !|
recent history? !|
a. Pyelonephritis
!|
b. Dehydration
!|
c. Bladder cancer
!| !|
d. Kidney stones - Correct answer ✔ANS: B
!| !| !| !| !| !| !|
Prerenal causes of AKI are related to a decrease in perfusion, such as in
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
clients who have prolonged dehydration. Pyelonephritis is an intrinsic or
!| !| !| !| !| !| !| !| !| !|
intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney
!| !| !| !| !| !| !| !| !| !| !| !|
stones are postrenal causes of AKI related to urine flow obstruction.
!| !| !| !| !| !| !| !| !| !|
2. A marathon runner comes into the clinic and states "I have not urinated
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
very much in the last few days." The nurse notes a heart rate of 110 beats/min
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
and a blood pressure of 86/58 mm Hg. Which action by the nurse is most
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
appropriate?
a. Give the client a bottle of water immediately.
!| !| !| !| !| !| !| !|
b. Start an intravenous line for fluids.
!| !| !| !| !| !|
c. Teach the patient to drink 2 to 3 L of water daily.
!| !| !| !| !| !| !| !| !| !| !| !|
d. Perform an electrocardiogram. - Correct answer ✔ANS: A
!| !| !| !| !| !| !| !|
,This athlete is mildly dehydrated as evidenced by the higher heart rate and
!| !| !| !| !| !| !| !| !| !| !| !| !|
lower blood pressure. The nurse can start hydrating the client with a bottle
!| !| !| !| !| !| !| !| !| !| !| !| !|
of water first, followed by teaching the patient to drink 2 to 3 L of water each
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
day. An intravenous line may be needed later, after the patient's degree of
!| !| !| !| !| !| !| !| !| !| !| !| !|
dehydration is assessed. An electrocardiogram is not necessary at this time.
!| !| !| !| !| !| !| !| !| !|
3. A client comes into the emergency department with a serum creatinine of
!| !| !| !| !| !| !| !| !| !| !| !| !|
2.2 mg/dL (1944 mcmol/L) and a blood urea nitrogen (BUN) of 24 mL/dL
!| !| !| !| !| !| !| !| !| !| !| !| !|
(8.57 mmol/L). What question would the nurse ask first when taking this
!| !| !| !| !| !| !| !| !| !| !| !|
client's history? !|
a. "Have you been taking any aspirin, ibuprofen, or naproxen recently?"
!| !| !| !| !| !| !| !| !| !|
b. "Do you have anyone in your family with renal failure?"
!| !| !| !| !| !| !| !| !| !|
c. "Have you had a diet that is low in protein recently?"
!| !| !| !| !| !| !| !| !| !| !|
d. "Has a relative had a kidney transplant lately?" - Correct answer ✔ANS: A
!| !| !| !| !| !| !| !| !| !| !| !| !|
There are some medications that are nephrotoxic, such as the nonsteroidal
!| !| !| !| !| !| !| !| !| !| !|
anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a !| !| !| !| !| !| !| !| !| !|
good question to initially ask the patient since both the serum creatinine and
!| !| !| !| !| !| !| !| !| !| !| !| !|
BUN are elevated, indicating some renal problems. A diet high in protein
!| !| !| !| !| !| !| !| !| !| !| !|
could be a factor in an increased BUN.
!| !| !| !| !| !| !|
4. A client is admitted with acute kidney injury (AKI) and a urine output of
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
2000 mL/day. What is the major concern of the nurse regarding this patient's
!| !| !| !| !| !| !| !| !| !| !| !| !|
care?
a. Edema and pain
!| !| !|
b. Cardiac and respiratory status
!| !| !| !|
c. Electrolyte and fluid imbalance
!| !| !| !|
d. Mental health status - Correct answer ✔ANS: C
!| !| !| !| !| !| !| !|
,This client may have an inflammatory cause of AKI with proteins entering
!| !| !| !| !| !| !| !| !| !| !| !|
the glomerulus and holding the fluid in the filtrate, causing polyuria.
!| !| !| !| !| !| !| !| !| !| !|
Electrolyte loss and fluid balance are essential. Edema and pain are not !| !| !| !| !| !| !| !| !| !| !| !|
usually a problem with fluid loss. There could be changes in the client's
!| !| !| !| !| !| !| !| !| !| !| !| !|
cardiac, respiratory, and mental health status if the electrolyte imbalance is
!| !| !| !| !| !| !| !| !| !| !|
not treated.!|
5. A client with acute kidney injury (AKI) has a blood pressure of 76/55 mm
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
Hg. The primary health care provider prescribed 1000 mL of normal saline to
!| !| !| !| !| !| !| !| !| !| !| !| !|
be infused over 1 hour to maintain perfusion. The client starts to develop
!| !| !| !| !| !| !| !| !| !| !| !| !|
shortness of breath. What is the nurse's priority action? !| !| !| !| !| !| !| !|
a. Calculate the mean arterial pressure (MAP).
!| !| !| !| !| !|
b. Ask for insertion of a pulmonary artery catheter.
!| !| !| !| !| !| !| !|
c. Take the client's pulse.
!| !| !| !|
d. Decrease the rate of the IV infusion. - Correct answer ✔ANS: D
!| !| !| !| !| !| !| !| !| !| !| !|
The nurse would assess that the client could be developing fluid overload
!| !| !| !| !| !| !| !| !| !| !| !|
and respiratory distress and slow down the normal saline infusion. The
!| !| !| !| !| !| !| !| !| !| !|
calculation of the MAP also reflects perfusion. The insertion of a pulmonary !| !| !| !| !| !| !| !| !| !| !| !|
artery catheter would evaluate the client's hemodynamic status, but this
!| !| !| !| !| !| !| !| !| !|
would not be the initial or priority action by the nurse. Vital signs are also
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
important after adjusting the intravenous infusion. !| !| !| !| !|
6. A client has a serum potassium level of 6.5 mEq/L (6.5 mmol/L), a serum
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
creatinine level of 2 mg/dL (176 mcmol/L), and a urine output of 350
!| !| !| !| !| !| !| !| !| !| !| !| !|
mL/day. What is the best action by the nurse? !| !| !| !| !| !| !| !|
a. Place the client on a cardiac monitor immediately.
!| !| !| !| !| !| !| !|
b. Teach the client to limit high-potassium foods.
!| !| !| !| !| !| !|
, c. Continue to monitor the client's intake and output.
!| !| !| !| !| !| !| !|
d. Ask to have the laboratory redraw the blood specimen. - Correct answer
!| !| !| !| !| !| !| !| !| !| !| !| !|
✔ANS: A !|
The best action by the nurse would be to check the cardiac status with a
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
monitor. High-potassium levels can lead to dysrhythmias. The other choices
!| !| !| !| !| !| !| !| !| !|
are logical nursing interventions for acute kidney injury but not the best
!| !| !| !| !| !| !| !| !| !| !| !|
immediate action. !|
7. A client with diabetes mellitus type 2 has been well controlled with
!| !| !| !| !| !| !| !| !| !| !| !| !|
metformin. The client is scheduled for magnetic resonance imaging (MRI)
!| !| !| !| !| !| !| !| !| !|
scan with contrast. What priority would the nurse take at this time?
!| !| !| !| !| !| !| !| !| !| !|
a. Teach the client about the purpose of the MRI.
!| !| !| !| !| !| !| !| !|
b. Assess the client's blood urea nitrogen and creatinine.
!| !| !| !| !| !| !| !|
c. Tell the client to withhold metformin for 24 hours before the MRI.
!| !| !| !| !| !| !| !| !| !| !| !|
d. Ask the client if he or she is taking antibiotics. - Correct answer ✔ANS: C
!| !| !| !| !| !| !| !| !| !| !| !| !| !| !|
Contrast media can be nephrotoxic (damaging to the kidneys). Metformin
!| !| !| !| !| !| !| !| !| !|
can also be nephrotoxic and the client should not be exposed to two agents.
!| !| !| !| !| !| !| !| !| !| !| !| !| !|
Clients who have diabetes are already at risk for renal damage.
!| !| !| !| !| !| !| !| !| !|
8. A client is started on continuous venovenous hemofiltration (CVVH).
!| !| !| !| !| !| !| !| !| !|
Which finding would require immediate action by the nurse?
!| !| !| !| !| !| !| !|
a. Potassium level of 5.5 mEq/L (5.5 mmol/L)
!| !| !| !| !| !| !|
b. Sodium level of 138 mEq/L (138 mmol/L)
!| !| !| !| !| !| !|
c. Blood pressure of 76/58 mm Hg
!| !| !| !| !| !|
d. Pulse rate of 88 beats/min - Correct answer ✔ANS: C
!| !| !| !| !| !| !| !| !| !|
