9 - Acute Kidney Injury & Chronic Kidney Disease
1. When a patient with acute kidney injury (AKI) has an arterial blood pH of
7.30, the nurse will expect an assessment finding of
A) persistent skin tenting
B) rapid, deep respirations
C) hot, flushed face & neck
D) bounding peripheral pulses: B) rapid, deep respirations
REASON: Patients with metabolic acidosis caused by AKI may have Kussmaul
respirations as the lungs try to regulate 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.
2. The nurse is planning care for a patient with severe heart failure who has
developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary
treatment goal in the plan will be
A) augmenting fluid volume
B) maintaining cardiac output
C) diluting nephrotoxic substances
D) preventing systemic hypertension: B) maintaining cardiac output
REASON: 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. For
renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses
would be correct.
3. 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?
1/8
, A) urine volume
B) calcium level
C) cardiac rhythm
D) neurologic status: C) cardiac rhythm
REASON: The calcium gluconate helps prevent dysrhythmias that might be caused by
the hyperkalemia. The nurse will monitor the other data as well, but these will not be
helpful in determining the effectiveness of the calcium gluconate.
4. 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 urinary output each day to help calculate the amount I can
drink."
d) "I need to take erythropoietin to boost my immune system and help prevent
infection.": c) "I will measure my urinary output each day to help calculate the
amount I can drink."
REASON: The patient with end-stage renal disease is taught to measure urine output as a
means of determining an appropriate oral fluid intake. 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.
5. Which menu choice by the patient who is receiving hemodialysis indicates that the
nurse's teaching has been successful?
a) Split-pea soup, English muffin, and nonfat milk
b) Oatmeal with cream, half a banana, and herbal tea
c) Poached eggs, whole-wheat toast, and apple juice
2/8
1. When a patient with acute kidney injury (AKI) has an arterial blood pH of
7.30, the nurse will expect an assessment finding of
A) persistent skin tenting
B) rapid, deep respirations
C) hot, flushed face & neck
D) bounding peripheral pulses: B) rapid, deep respirations
REASON: Patients with metabolic acidosis caused by AKI may have Kussmaul
respirations as the lungs try to regulate 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.
2. The nurse is planning care for a patient with severe heart failure who has
developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary
treatment goal in the plan will be
A) augmenting fluid volume
B) maintaining cardiac output
C) diluting nephrotoxic substances
D) preventing systemic hypertension: B) maintaining cardiac output
REASON: 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. For
renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses
would be correct.
3. 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?
1/8
, A) urine volume
B) calcium level
C) cardiac rhythm
D) neurologic status: C) cardiac rhythm
REASON: The calcium gluconate helps prevent dysrhythmias that might be caused by
the hyperkalemia. The nurse will monitor the other data as well, but these will not be
helpful in determining the effectiveness of the calcium gluconate.
4. 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 urinary output each day to help calculate the amount I can
drink."
d) "I need to take erythropoietin to boost my immune system and help prevent
infection.": c) "I will measure my urinary output each day to help calculate the
amount I can drink."
REASON: The patient with end-stage renal disease is taught to measure urine output as a
means of determining an appropriate oral fluid intake. 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.
5. Which menu choice by the patient who is receiving hemodialysis indicates that the
nurse's teaching has been successful?
a) Split-pea soup, English muffin, and nonfat milk
b) Oatmeal with cream, half a banana, and herbal tea
c) Poached eggs, whole-wheat toast, and apple juice
2/8
