Science Medicine Nursing
Chapter 60: Concepts of Care for Patients with Acute
Kidney Injury and Chronic Kidney Disease Ignatavicius:
Medical-Surgical Nursing, 11th Edition
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Terms in this set (36)
1. The nurse is assessing a client with a diagnosis of pre- ANS: B
renal acute kidney injury (AKI). Which condition would the Pre-renal causes of AKI are related to a decrease in perfusion, such as with a
nurse expect to find in the client's recent history? myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI
a. Pyelonephritis related to kidney damage. Bladder cancer and kidney stones are post-renal
b. Myocardial infarction causes of AKI related to urine flow obstruction.
c. Bladder cancer
d. Kidney stones
2. A marathon runner comes into the clinic and states "I ANS: A
have not urinated very much in the last few days." The This athlete is mildly dehydrated as evidenced by the higher heart rate and lower
nurse notes a heart rate of 110 beats/min and a blood blood pressure. The nurse can start hydrating the client with a bottle of water first,
pressure of 86/58 mm Hg. Which action by the nurse is followed by teaching the client to drink 2 to 3 liters of water each day. An
the priority? intravenous line may be ordered later, after the client's degree of dehydration is
a. Give the client a bottle of water immediately. assessed. An electrocardiogram is not necessary at this time.
b. Start an intravenous line for fluids.
c. Teach the client to drink 2 to 3 liters of water daily.
d. Perform an electrocardiogram.
3. A male client comes into the emergency department ANS: A
with a serum creatinine of 2.2 mg/dL and a blood urea There are some medications that are nephrotoxic, such as the nonsteroidal anti-
nitrogen (BUN) of 24 mL/dL. What question should the inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good
nurse ask first when taking this client's history? question to initially ask the client since both the serum creatinine and BUN are
a. "Have you been taking any aspirin, ibuprofen, or elevated, indicating some renal problems. A family history of renal failure and
naproxen recently?" kidney transplantation would not be part of the questioning and could cause
b. "Do you have anyone in your family with renal failure?" anxiety in the client. A diet high in protein could be a factor in an increased BUN.
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?"
, 4. A client is admitted with acute kidney injury (AKI) and a ANS: B
urine output of 2000 mL/day. What is the major concern This client may have an inflammatory cause of AKI with proteins entering the
of the nurse regarding this client's care? glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss
a. Edema and pain and fluid balance is essential. Edema and pain are not usually a problem with fluid
b. Electrolyte and fluid imbalance loss. There could be changes in the client's cardiac, respiratory, and mental health
c. Cardiac and respiratory status status if the electrolyte imbalance is not treated.
d. Mental health status
5. A client with acute kidney injury has a blood pressure ANS: D
of 76/55 mm Hg. The health care provider ordered 1000 The nurse should assess that the client could be developing fluid overload and
mL of normal saline to be infused over 1 hour to maintain respiratory distress and slow down the normal saline infusion. The calculation of
perfusion. The client is starting to develop shortness of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter
breath. What is the nurse's priority action? would evaluate the client's hemodynamic status, but this should not be the initial
a. Calculate the mean arterial pressure (MAP). action by the nurse. Vital signs are also important after adjusting the intravenous
b. Ask for insertion of a pulmonary artery catheter. infusion.
c. Take the client's pulse.
d. Slow down the normal saline infusion.
6. A client has a serum potassium level of 6.5 mmol/L, a ANS: A
serum creatinine level of 2 mg/dL, and a urine output of The priority action by the nurse should be to check the cardiac status with a
350 mL/day. What is the best action by the nurse? monitor. High potassium levels can lead to dysrhythmias. The other choices are
a. Place the client on a cardiac monitor immediately. logical nursing interventions for acute kidney injury but not the best immediate
b. Teach the client to limit high-potassium foods. action.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen.
7. A client has just had a central line catheter placed that ANS: D
is specific for hemodialysis. What is the most appropriate The central line should have a heparin or heparin/saline dwell after hemodialysis
action by the nurse? treatment. The central line catheter used for dialysis should not be used for blood
a. Use the catheter for the next laboratory blood draw. sampling, monitoring central venous pressures, or giving drugs or fluids.
b. Monitor the central venous pressure through this line.
c. Access the line for the next intravenous medication.
d. Place a heparin or heparin/saline dwell after
hemodialysis.
8. A client in the intensive care unit is started on ANS: A
continuous venovenous hemofiltration (CVVH). Which Hypotension can be a problem with CVVH if replacement fluid does not provide
finding is the cause of immediate action by the nurse? enough volume to maintain blood pressure. The specially trained nurse needs to
a. Blood pressure of 76/58 mm Hg monitor for ongoing fluid and electrolyte replacement. The sodium level is normal
b. Sodium level of 138 mEq/L and the potassium level is slightly elevated, which could be normal findings for
c. Potassium level of 5.5 mEq/L someone with acute kidney injury. A pulse rate of 90 beats/min is normal.
d. Pulse rate of 90 beats/min
9. The nurse is caring for four clients with chronic kidney ANS: B
disease. Which client should the nurse assess first upon Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The
initial rounding? client is increasing the rate and depth of breathing to excrete carbon dioxide
a. Woman with a blood pressure of 158/90 mm Hg through the lungs. Hypertension is common in most clients with CKD, and skin
b. Client with Kussmaul respirations itching increases with calcium-phosphate imbalances, another common finding in
c. Man with skin itching from head to toe CKD. Uremia from CKD causes ammonia to be formed, resulting in the common
d. Client with halitosis and stomatitis findings of halitosis and stomatitis. Skills: Business exams may require students to present
ideas clearly and concisely. Students must convey complex concepts in a way that demonstrates
their understanding of business principles.1.4. Preparing for Business ExamsPreparing for business
exams involves mastering
Chapter 60: Concepts of Care for Patients with Acute
Kidney Injury and Chronic Kidney Disease Ignatavicius:
Medical-Surgical Nursing, 11th Edition
Leave the first rating
Save
Skills: Business exams may require students to present ideas clearly and concisely. Students must convey complex concepts in a way that demonstrates their understanding of
business principles.1.4. Preparing for Business ExamsPreparing for business exams involves mastering
Students also studied
C
Terms in this set (36)
1. The nurse is assessing a client with a diagnosis of pre- ANS: B
renal acute kidney injury (AKI). Which condition would the Pre-renal causes of AKI are related to a decrease in perfusion, such as with a
nurse expect to find in the client's recent history? myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI
a. Pyelonephritis related to kidney damage. Bladder cancer and kidney stones are post-renal
b. Myocardial infarction causes of AKI related to urine flow obstruction.
c. Bladder cancer
d. Kidney stones
2. A marathon runner comes into the clinic and states "I ANS: A
have not urinated very much in the last few days." The This athlete is mildly dehydrated as evidenced by the higher heart rate and lower
nurse notes a heart rate of 110 beats/min and a blood blood pressure. The nurse can start hydrating the client with a bottle of water first,
pressure of 86/58 mm Hg. Which action by the nurse is followed by teaching the client to drink 2 to 3 liters of water each day. An
the priority? intravenous line may be ordered later, after the client's degree of dehydration is
a. Give the client a bottle of water immediately. assessed. An electrocardiogram is not necessary at this time.
b. Start an intravenous line for fluids.
c. Teach the client to drink 2 to 3 liters of water daily.
d. Perform an electrocardiogram.
3. A male client comes into the emergency department ANS: A
with a serum creatinine of 2.2 mg/dL and a blood urea There are some medications that are nephrotoxic, such as the nonsteroidal anti-
nitrogen (BUN) of 24 mL/dL. What question should the inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good
nurse ask first when taking this client's history? question to initially ask the client since both the serum creatinine and BUN are
a. "Have you been taking any aspirin, ibuprofen, or elevated, indicating some renal problems. A family history of renal failure and
naproxen recently?" kidney transplantation would not be part of the questioning and could cause
b. "Do you have anyone in your family with renal failure?" anxiety in the client. A diet high in protein could be a factor in an increased BUN.
c. "Have you had a diet that is low in protein recently?"
d. "Has a relative had a kidney transplant lately?"
, 4. A client is admitted with acute kidney injury (AKI) and a ANS: B
urine output of 2000 mL/day. What is the major concern This client may have an inflammatory cause of AKI with proteins entering the
of the nurse regarding this client's care? glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss
a. Edema and pain and fluid balance is essential. Edema and pain are not usually a problem with fluid
b. Electrolyte and fluid imbalance loss. There could be changes in the client's cardiac, respiratory, and mental health
c. Cardiac and respiratory status status if the electrolyte imbalance is not treated.
d. Mental health status
5. A client with acute kidney injury has a blood pressure ANS: D
of 76/55 mm Hg. The health care provider ordered 1000 The nurse should assess that the client could be developing fluid overload and
mL of normal saline to be infused over 1 hour to maintain respiratory distress and slow down the normal saline infusion. The calculation of
perfusion. The client is starting to develop shortness of the MAP also reflects perfusion. The insertion of a pulmonary artery catheter
breath. What is the nurse's priority action? would evaluate the client's hemodynamic status, but this should not be the initial
a. Calculate the mean arterial pressure (MAP). action by the nurse. Vital signs are also important after adjusting the intravenous
b. Ask for insertion of a pulmonary artery catheter. infusion.
c. Take the client's pulse.
d. Slow down the normal saline infusion.
6. A client has a serum potassium level of 6.5 mmol/L, a ANS: A
serum creatinine level of 2 mg/dL, and a urine output of The priority action by the nurse should be to check the cardiac status with a
350 mL/day. What is the best action by the nurse? monitor. High potassium levels can lead to dysrhythmias. The other choices are
a. Place the client on a cardiac monitor immediately. logical nursing interventions for acute kidney injury but not the best immediate
b. Teach the client to limit high-potassium foods. action.
c. Continue to monitor the client's intake and output.
d. Ask to have the laboratory redraw the blood specimen.
7. A client has just had a central line catheter placed that ANS: D
is specific for hemodialysis. What is the most appropriate The central line should have a heparin or heparin/saline dwell after hemodialysis
action by the nurse? treatment. The central line catheter used for dialysis should not be used for blood
a. Use the catheter for the next laboratory blood draw. sampling, monitoring central venous pressures, or giving drugs or fluids.
b. Monitor the central venous pressure through this line.
c. Access the line for the next intravenous medication.
d. Place a heparin or heparin/saline dwell after
hemodialysis.
8. A client in the intensive care unit is started on ANS: A
continuous venovenous hemofiltration (CVVH). Which Hypotension can be a problem with CVVH if replacement fluid does not provide
finding is the cause of immediate action by the nurse? enough volume to maintain blood pressure. The specially trained nurse needs to
a. Blood pressure of 76/58 mm Hg monitor for ongoing fluid and electrolyte replacement. The sodium level is normal
b. Sodium level of 138 mEq/L and the potassium level is slightly elevated, which could be normal findings for
c. Potassium level of 5.5 mEq/L someone with acute kidney injury. A pulse rate of 90 beats/min is normal.
d. Pulse rate of 90 beats/min
9. The nurse is caring for four clients with chronic kidney ANS: B
disease. Which client should the nurse assess first upon Kussmaul respirations indicate a worsening of chronic kidney disease (CKD). The
initial rounding? client is increasing the rate and depth of breathing to excrete carbon dioxide
a. Woman with a blood pressure of 158/90 mm Hg through the lungs. Hypertension is common in most clients with CKD, and skin
b. Client with Kussmaul respirations itching increases with calcium-phosphate imbalances, another common finding in
c. Man with skin itching from head to toe CKD. Uremia from CKD causes ammonia to be formed, resulting in the common
d. Client with halitosis and stomatitis findings of halitosis and stomatitis. Skills: Business exams may require students to present
ideas clearly and concisely. Students must convey complex concepts in a way that demonstrates
their understanding of business principles.1.4. Preparing for Business ExamsPreparing for business
exams involves mastering
