Milestone Chapter 68: Care of Patients with Acute Kidney In- jury and Chronic Kidney Disease(Concepts for Interprofessional Collaborative Care College Test Bank)

Milestone Chapter 68: Care of Patients with Acute Kidney In- jury and Chronic Kidney Disease(Concepts for Interprofessional Collaborative Care College Test Bank)MULTIPLE CHOICE 1. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client’s recent history? a. Pyelonephritis b. Myocardial infarction c. Bladder cancer d. Kidney stones ANS: B Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction. DIF: Understanding/Comprehension REF: 1412 KEY: Renal system| pathophysiology| nursing analysis MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 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 the priority? a. Give the client a bottle of water immediately. b. Start an intravenous line for fluids. c. Teach the client to drink 2 to 3 liters of water daily. d. Perform an electrocardiogram. 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 client to drink 2 to 3 liters of water each day. An intravenous line may be ordered later, after the client’s degree of dehydration is assessed. An electrocardiogram is not necessary at this time. DIF: Applying/Application REF: 1414 KEY: Renal system| dehydration| nursing interventions MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 3. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should 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?” ANS: A There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibupro- fen, aspirin, and naproxen. This would be a good question to initially ask the client since both the serum creati- nine and BUN are elevated, indicating some renal problems. A family history of renal failure and kidney trans- plantation would not be part of the questioning and could cause anxiety in the client. A diet high in protein could be a factor in an increased BUN. DIF: Applying/Application REF: 1413 KEY: Renal system| medications| nursing assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major con- cern of the nurse regarding this client’s care? a. Edema and pain b. Electrolyte and fluid imbalance c. Cardiac and respiratory status d. Mental health status ANS: B 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 is 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. DIF: Applying/Application REF: 1416 KEY: Renal system| pathophysiology| dehydration MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 5. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting 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. Slow down the normal saline infusion. ANS: D The nurse should 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 pul- monary artery catheter would evaluate the client’s hemodynamic status, but this should not be the initial ac- tion by the nurse. Vital signs are also important after adjusting the intravenous infusion. DIF: Applying/Application REF: 1416 KEY: Renal system| hemodynamic status| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 6. A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, 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. ANS: A The priority action by the nurse should 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. DIF: Applying/Application REF: 1421 KEY: Renal system| electrolyte imbalance| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 7. A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appro- priate action by the nurse? a. Use the catheter for the next laboratory blood draw. 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. ANS: D The central line should have a heparin or heparin/saline dwell after hemodialysis treatment. The central line catheter used for dialysis should not be used for blood sampling, monitoring central venous pressures, or giv- ing drugs or fluids. DIF: Remembering/Knowledge REF: 1435 KEY: Renal system| vascular access device| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control..............continued*