Chapter 51: Acute Kidney Injury and Chronic Kidney Disease ||Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE 1. After an arteriovenous graft is inserted in a patient‘s right forearm, the patient reports pain and coldness in the right fingers. Which action would the nurse take? a. Remind the patient to take a daily low-dose aspirin tablet. b. Report the patient‘s symptoms to the health care provider. c. Elevate the patient‘s arm on pillows above the heart level. d. Teach the patient about normal arteriovenous graft function. ANS: B The patient‘s problems suggest the development of distal ischemia (steal syndrome) and may require revision of the arteriovenous graft (AVG). Elevating the arm above the heart will further decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. Which assessment finding would the nurse expect when a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30? a. Persistent skin tenting b. Rapid, deep respirations c. Hot, flushed face and neck d. Bounding peripheral pulses ANS: B Patients with metabolic acidosis caused by AKI may have Kussmaul respirations to eliminate carbon dioxide. Bounding pulses and vasodilation are not associated with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin turgor would not be a finding in AKI. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 3. The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. Which aim will be the primary treatment goal? a. Augmenting fluid volume b. Maintaining cardiac output c. Diluting nephrotoxic substances d. Preventing systemic hypertension ANS: B The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient‘s heart failure is causing AKI, the care will be directed toward treatment of the heart failure. Renal failure caused by hypertension, hypovolemia, or nephrotoxins would be managed by interventions specific to those problems. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 4. A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV? a. Urine volume b. Calcium level c. Cardiac rhythm d. Neurologic status ANS: C Calcium gluconate raises the threshold at which dysrhythmias occur, temporarily stabilizing the myocardium. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 5. Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse‘s teaching about management of CKD has been effective? a. “I need to get most of my protein from low-fat dairy products.” b. “I will increase my intake of fruits and vegetables to 5 per day.” c. “I will measure my output each day to help calculate the amount I can drink.” d. “I need erythropoietin injections to boost my immunity and prevent infection.” ANS: C The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake; the total urine output plus 600-1000 ml is the daily fluid allowance. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 6. Which information will the nurse monitor to determine the effectiveness of prescribed calcium carbonate (Caltrate) for a patient with chronic kidney disease (CKD)? a. Blood pressure b. Phosphate level c. Neurologic status d. Creatinine clearance