RNSG 2432 Exam 2: AKI and CKD Questions With
Complete Solutions
*R*IFLE Correct Answer severity: risk class⟶ at risk of AKI
2 categories of immunosuppressant medications Correct
Answer Induction agents⟶ powerful antirejection
medications *used at time of transplant*
Maintenance agents⟶ *long-term* antirejection meds
4 phases of AKI Correct Answer onset⟶ hours to days
oliguric⟶ 1-7 days (can last 10 days to months)
diuretic⟶ until UOP improves
recovery⟶ until concrete proof is shown in labs
5 stages of CKD in GFR Correct Answer Stage 1 GFR >90⟶
normal kidney function
Stage 2 GFR 60-89⟶ early stage kidney disease
Stage 3 GFR 30-59
Stage 4 GFR 15-29
*Stage 5 GFR <15*⟶ kidney failure
a kidney transplant is a treatment and not a Correct Answer
cure
A patient is diagnosed with chronic renal failure and told she
must start hemodialysis. Patient teaching would include which
of the following instructions?
A. Follow a high potassium diet
B. Strictly follow the hemodialysis schedule
,C. There will be a few changes in your lifestyle
D. Use alcohol on the skin and clean it due to integumentary
changes. Correct Answer B. Strictly follow the hemodialysis
schedule
A patient is undergoing peritoneal dialysis. The dialysate dwell
time is completed, and the dwell clamp is opened to allow the
dialysate to drain. The nurse notes that the drainage has stopped
and only 500 ml has drained; the amount the dialysate instilled
was 1,500 ml. Which of the following interventions would be
done first?
A. Change the patient's position
B. Call the physician
C. Check the catheter for kinks or obstruction.
D. Clamp the catheter and instill more dialysate at the next
exchange time. Correct Answer C. Check the catheter for kinks
or obstruction.
A patient receiving hemodialysis treatment arrives at the
hospital with a blood pressure of 200/100, a heart rate of 110,
and a respiratory rate of 36. Oxygen saturation on room air is
89%. He complains of shortness of breath, and 2+ pedal edema
is noted. His last hemodialysis treatment was yesterday. Which
of the following interventions should be done first?
A. Administer oxygen
B. Elevate the foot of the bed
C. Restrict the patient's fluids
D. Prepare the patient for hemodialysis. Correct Answer A.
Administer oxygen
,accelerated transplant rejection Correct Answer 1st week to
one month, same as hyperacute but slower
Rx = removal
Activated Vit D is required for Correct Answer absorption of
Calcium
acute kidney injury (AKI) usually pertains to Correct Answer a
short term kidney problem but may lead to chronic kidney
problems
most pts can return to normal kidney fx
acute transplant rejection Correct Answer First 6 months, 50%
experience rejection vs cyclosporine toxicity
*Weight gain, ↑BUN/Cr*, site tenderness, fever, *↓UOP*,
HTN, increased infx risk
Rx = Usually reversible with additional immunosuppressants
advantages of kidney transplant Correct Answer Restoration of
"normal" renal function
Freedom from dialysis
Return to "normal" life
Reverses pathophysiological changes r/t Renal Failure
Less expensive than dialysis after 1st year
Advantages of peritoneal dialysis Correct Answer
Independence for patient
easier on the body system
No needle sticks
Better blood pressure control
Some diabetics add insulin to solution
, Fewer dietary restrictions
○ Protein loses in dialysate
○ Generally need ↑ potassium
○ Less fluid restrictions
AKI complication prevention Correct Answer Watch for early
s/sx AKI⟶ oliguria <400mL
Caution with contrast dye, nephrotoxic agents and other risk
factors
AKI treatment goals Correct Answer Determine/treat cause
Manage s/sx
Prevent complications
AKI treatments Correct Answer Phosphorus
Calcium
Hypertension
Anemia
Nutritional Considerations
Emergency dialysis
AKI tx: manage fluid balances Correct Answer Strict I&O,
daily weights
relevant labs⟶ BUN/Cr, GFR, UOP, Na, K+, WBC, urine
specific gravity
Fluids during oliguric phase⟶ BLAST THEM
if fluids fail⟶ diuretic therapy
if diuretics fail⟶ restrict fluids
Complete Solutions
*R*IFLE Correct Answer severity: risk class⟶ at risk of AKI
2 categories of immunosuppressant medications Correct
Answer Induction agents⟶ powerful antirejection
medications *used at time of transplant*
Maintenance agents⟶ *long-term* antirejection meds
4 phases of AKI Correct Answer onset⟶ hours to days
oliguric⟶ 1-7 days (can last 10 days to months)
diuretic⟶ until UOP improves
recovery⟶ until concrete proof is shown in labs
5 stages of CKD in GFR Correct Answer Stage 1 GFR >90⟶
normal kidney function
Stage 2 GFR 60-89⟶ early stage kidney disease
Stage 3 GFR 30-59
Stage 4 GFR 15-29
*Stage 5 GFR <15*⟶ kidney failure
a kidney transplant is a treatment and not a Correct Answer
cure
A patient is diagnosed with chronic renal failure and told she
must start hemodialysis. Patient teaching would include which
of the following instructions?
A. Follow a high potassium diet
B. Strictly follow the hemodialysis schedule
,C. There will be a few changes in your lifestyle
D. Use alcohol on the skin and clean it due to integumentary
changes. Correct Answer B. Strictly follow the hemodialysis
schedule
A patient is undergoing peritoneal dialysis. The dialysate dwell
time is completed, and the dwell clamp is opened to allow the
dialysate to drain. The nurse notes that the drainage has stopped
and only 500 ml has drained; the amount the dialysate instilled
was 1,500 ml. Which of the following interventions would be
done first?
A. Change the patient's position
B. Call the physician
C. Check the catheter for kinks or obstruction.
D. Clamp the catheter and instill more dialysate at the next
exchange time. Correct Answer C. Check the catheter for kinks
or obstruction.
A patient receiving hemodialysis treatment arrives at the
hospital with a blood pressure of 200/100, a heart rate of 110,
and a respiratory rate of 36. Oxygen saturation on room air is
89%. He complains of shortness of breath, and 2+ pedal edema
is noted. His last hemodialysis treatment was yesterday. Which
of the following interventions should be done first?
A. Administer oxygen
B. Elevate the foot of the bed
C. Restrict the patient's fluids
D. Prepare the patient for hemodialysis. Correct Answer A.
Administer oxygen
,accelerated transplant rejection Correct Answer 1st week to
one month, same as hyperacute but slower
Rx = removal
Activated Vit D is required for Correct Answer absorption of
Calcium
acute kidney injury (AKI) usually pertains to Correct Answer a
short term kidney problem but may lead to chronic kidney
problems
most pts can return to normal kidney fx
acute transplant rejection Correct Answer First 6 months, 50%
experience rejection vs cyclosporine toxicity
*Weight gain, ↑BUN/Cr*, site tenderness, fever, *↓UOP*,
HTN, increased infx risk
Rx = Usually reversible with additional immunosuppressants
advantages of kidney transplant Correct Answer Restoration of
"normal" renal function
Freedom from dialysis
Return to "normal" life
Reverses pathophysiological changes r/t Renal Failure
Less expensive than dialysis after 1st year
Advantages of peritoneal dialysis Correct Answer
Independence for patient
easier on the body system
No needle sticks
Better blood pressure control
Some diabetics add insulin to solution
, Fewer dietary restrictions
○ Protein loses in dialysate
○ Generally need ↑ potassium
○ Less fluid restrictions
AKI complication prevention Correct Answer Watch for early
s/sx AKI⟶ oliguria <400mL
Caution with contrast dye, nephrotoxic agents and other risk
factors
AKI treatment goals Correct Answer Determine/treat cause
Manage s/sx
Prevent complications
AKI treatments Correct Answer Phosphorus
Calcium
Hypertension
Anemia
Nutritional Considerations
Emergency dialysis
AKI tx: manage fluid balances Correct Answer Strict I&O,
daily weights
relevant labs⟶ BUN/Cr, GFR, UOP, Na, K+, WBC, urine
specific gravity
Fluids during oliguric phase⟶ BLAST THEM
if fluids fail⟶ diuretic therapy
if diuretics fail⟶ restrict fluids
