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1. Which assessment findings would the health care provider consider as most
indicative of acute renal failure?
A. Alterations in blood pH; peripheral edema
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B. Increased nitrogenous waste levels; decreased glomerular
filtration rate (GFR)
C. Decreased serum creatinine and blood urea nitrogen (BUN); decreased
potassium and calcium levels
D. Decreased urine output; hematuria; increased glomerular filtration rate (GFR)
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Answer: B
Rationale: The hallmark of acute renal injury is azotemia,
an accumulation of
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nitrogenous wastes such as creatinine, urea nitrogen, and uric acid plus a decrease
in the GFR of the kidneys. While pH alterations, edema, electrolyte imbalances and
decreased urine output may accompany acute renal failure, they are all potentially
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attributable to other pathologies. Creatinine, GFR, and BUN
would be unlikely to
rise during renal failure.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
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Cognitive Level: Analyze
Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 892
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2. Which teaching points about acute tubular necrosis (ATN) should the renal nurse
educator include in the orientation session of new nurses?
A. "The cardinal signs of ATN are oliguria and retention of potassium, creatinine and
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sulfates."
B. "Ureteral and bladder outlet obstructions are often contributors to ATN."
C. "Trauma, burns, and major surgery are common precursors to ATN."
D. "Tubular epithelial cells are sensitive to ischemia andabirb.com/test
toxins, and damage is
irreversible."
Answer: C
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Rationale: ATN is often preceded by major surgery, burns, or trauma. Many cases
of ATN are nonoliguric, and obstructions that are postrenal in nature are not
common causes of ATN. Damage to tubular epithelial cells
is not necessarily
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irreversible.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
abirb.com/test
Cognitive Level: Apply
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 892
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3. Which clients scheduled for an interventional radiology procedure requiring
administration of radiocontrast dye would be considered high risk for
nephrotoxicity? Select all that apply.
A. Adolescent with severe abdominal pain
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WWW.THENURSINGMASTERY.COM
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B. Young adult with a history of glomerular nephritis who is reporting severe flank
pain
C. Middle-aged adult with diabetes undergoing diagnostic testing for new-onset
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proteinuria
D. Adult with elevated liver enzymes possibly due to fatty liver cirrhosis
E. Middle-aged adult undergoing biopsy for a suspicious "spot" on a chest x-ray
Answer: B, C
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Rationale: Radiocontrast media-induced nephrotoxicity is thought to result from
direct tubular toxicity and renal ischemia. The risk for renal
damage caused by
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radiocontrast media is greatest in older adults and those with preexisting kidney
disease, volume depletion, diabetes mellitus, and recent exposure to other
nephrotoxic agents.
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Question format: Multiple Select
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Reduction of Risk Potential
abirb.com/test
Reference: p. 893
4. An ultramarathon runner is admitted following a day-long, 50-mile (80abirb.com/testand the urine is
kilometer) race because urinary volume is drastically decreased
dark red. What is the likely cause of the red urine?
A. Hematuria
B. Hemoglobinuria
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C. Myoglobinuria
D. Kidney bleeding
Answer: C
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Rationale: Myoglobinuria, which can cause acute tubular necrosis via intratubular
obstruction, involves the leaching of myoglobin from skeletal muscle into the urine,
bypassing the usual filtration by the glomerulus. Excess abirb.com/test
exercise and muscle
trauma can contribute. While both hemoglobinuria and myoglobinuria discolor the
urine, hemoglobinuria results from hemolysis following a reaction to a blood
transfusion, whereas myoglobinuria involves muscle damage.
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Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
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Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 892
5. Following the diagnosis of acute renal failure, the nurse knows that one of the
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earliest manifestations of tubular damage is which laboratory/diagnostic result?
A. Elevated blood urea nitrogen (BUN)
B. Serum creatinine elevation
C. Inability to concentrate urine
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D. Reduced glomerular filtration rate
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WWW.THENURSINGMASTERY.COM
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Answer: C
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Rationale: Urine tests that measure urine osmolality, urinary
sodium concentration,
and fractional excretion of sodium help differentiate prerenal azotemia, in which the
reabsorptive capacity of the tubular cells is maintained, from tubular necrosis, in
which these functions are lost. One of the earliest manifestations of tubular damage
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is the inability to concentrate urine. Conventional markers of serum creatinine and
urea nitrogen, fractional secretion of sodium to assess glomerular filtration rate
(GFR), and urine output do not manifest for 1 to 2 days after the acute renal failure
has begun.
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Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Understand
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Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 892
6. A health care provider for an obese male who has a history
of diabetes and
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hypertension reports that the client's glomerular filtration rate (GFR) is 51 mL/min
with elevated serum creatinine levels. Which statement by the health care provider
will likely answer the client's question about the result?
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A. "We will regularly monitor your kidney function, but most
likely your kidneys will
be able to compensate on their own and intervention is not required."
B. "You likely have chronic kidney disease and there may be urine in your blood
until it is controlled."
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C. "Your chronic kidney disease has likely been caused by your diabetes and high
blood pressure."
D. "You are in kidney failure and I will be starting dialysis treatment immediately."
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Answer: C
Rationale: Diabetes and hypertension are conditions that can cause chronic kidney
disease (CKD). While the kidneys do have a remarkableabirb.com/test
ability to compensate for
impaired function, this fact does not mean that treatment would not be undertaken.
Hematuria is not a common manifestation of CKD. The client's GFR of 51 mL/min
does not indicate kidney failure or the need for dialysis. abirb.com/test
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
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Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 895
7. A nurse is collecting a urine specimen prior to measuring the albumin level in a
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client's urine. A colleague states, "I thought albumin was related to liver function,
not the kidney." How can the nurse best respond to this statement?
A. "Urine should normally be free of any proteins, and albumin is one of the more
common proteins to be excreted in chronic renal failure."
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B. "Urine albumin levels are useful for diagnosing diabetic kidney disease."
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WWW.THENURSINGMASTERY.COM
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C. "A urine dipstick test will tell us exactly how much albumin is being spilled by the
kidneys."
D. "A urine test for albumin allows us to estimate the glomerular filtration rate quite
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accurately."
Answer: B
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Rationale: In clients with diabetes, albumin tests are a useful adjunctive test of
nephron injury and repair. Urine is not normally completely free of proteins and a
urine dipstick does not allow for the quantification of how much albumin is in a
sample. Albumin tests do not allow for an accurate indirect
indication of glomerular
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filtration rate.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
abirb.com/test
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 896
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8. Which clinical manifestations would lead the nurse to suspect that a client with
renal failure is developing uremia? Select all that apply.
A. Weakness and fatigue.
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B. Lethargy and confusion.
C. Extreme itching.
D. Blood in urine.
E. Urine smell in the stool.
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Answer: A, B, C
Rationale: Uremia affects all body systems. The symptoms
at the onset include
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weakness, fatigue, nausea, and apathy. These are subtle signs. More severe
symptoms include extreme weakness, frequent vomiting, lethargy, and confusion.
Pruritis often accompanies the uremic state as well. The term uremia literally
means "urine in the blood"; however, it does not cause abirb.com/test
the appearance of blood in
urine (hematuria). There is no direct effect on the gastrointestinal system, so the
smell of stool does not change.
Question format: Multiple Select
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Reduction of Risk Potential
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Reference: p. 900
9. Which diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?
A. A client with high pH, low levels of calcium, and low levels of phosphate
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B. A client with low vitamin D levels, low calcitrol levels, and elevated parathyroid
hormone (PTH) levels
C. A client with low bone density, low levels of calcium, and low levels of phosphate
D. A client with low potassium levels, low calcitriol levels,
and increased parathyroid
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hormone (PTH) levels
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WWW.THENURSINGMASTERY.COM
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Answer: B
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Rationale: CKD is associated with low vitamin D and calcitrol
levels, which induces
increased PTH production. CKD is also associated with acidosis (low pH), high levels
of phosphate and hyperkalemia.
Question format: Multiple Choice
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 898
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10. Which medication would the nurse anticipate being prescribed for the client with
renal failure who has hyperphosphatemia?
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A. Vitamin D (Calcitriol)
B. Calcium carbonate
C. Levothyroxine
D. Cinacalcet
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Answer: B
Rationale: Phosphate-binding antacids (aluminum salts,abirb.com/test
calcium carbonate, or
calcium acetate) may be prescribed to decrease the absorption of phosphate from
the gastrointestinal tract.
Question format: Multiple Choice
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Reference: p. 899
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11. To maintain hematocrit levels in clients with kidney failure, the nurse should be
prepared to perform which intervention?
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A. Arrange for frequent blood transfusions in an outpatient
clinic.
B. Administer iron dextran intravenously.
C. Administer a subcutaneous injection of recombinant human erythropoietin
(rhEPO).
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D. Administer prenatal vitamins twice a day.
Answer: C
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Rationale: Recombinant human erythropoietin (rhEPO) helps maintain hematocrit
levels in people with kidney failure. Secondary benefits include improvement in
appetite, energy level, sexual function, skin color, hair and nail growth, and
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reduced cold intolerance. Blood transfusion is a treatment if symptomatic with low
hemoglobin; however, the health care provider will try to prevent this by giving
EPO. IV iron dextran is for severe iron-deficiency anemia and may be used as part
of the treatment of anemia in chonic kidney disease butabirb.com/test
is not the first choice for
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WWW.THENURSINGMASTERY.COM
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iron supplementation. Prenatal vitamins are high in vitamins but not designed for
clients with renal failure.
Question format: Multiple Choice
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Reference: p. 899
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12. A nurse is performing client education with an adult recently diagnosed with
chronic kidney disease. Which statement by the client would the nurse most likely
want to correct or clarify?
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A. "I will be prone to anemia, since I am not producing as much of the hormone
that causes my bones to produce red blood cells."
B. "My heart rate might go up because of my kidney disease and my blood might be
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a lot thinner than it should be."
C. "My kidney problems increase my chance of developing high blood pressure or
diabetes."
D. "I will have a risk of either bleeding too easily or possibly
clotting too quickly,
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though dialysis can help minimize these effects."
Answer: C
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Rationale: While high blood pressure can be causative of—or consequent to—renal
failure, diabetes is not normally a result of existing chronic kidney disease. Persons
with renal failure are indeed prone to anemia, increased heart rate, decreased
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blood viscosity, and coagulopathies. The risk of bleeding and thrombotic disorders
can be partially mitigated by dialysis.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
abirb.com/test
Cognitive Level: Apply
Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 898
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13. The nurse assesses a client with renal failure for encephalopathy caused by
uremia. Which clinical manifestation will the nurse likely find?
A. Severe chest pain with pericardial friction rub on auscultation.
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B. Stiff immobile joints and contractures.
C. Loss of recent memory and inattention.
D. Pruritus with yellow hue to skin tone.
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Answer: C
Rationale: Reductions in alertness and awareness are the earliest and most
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significant indications of uremic encephalopathy. These often are followed by an
inability to fix attention, loss of recent memory, and perceptual errors in identifying
people and objects. Chest pain and friction rub can result from uremia-related
pericarditis. Joint pain is not associated with uremia. Although
pruritus can occur
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WWW.THENURSINGMASTERY.COM
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due to uremia, having a yellow hue to the skin is jaundice (which is associated with
liver dysfunction).
Question format: Multiple Choice
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 900
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14. Which phenomenon contributes to the difficulties with absorption, distribution,
and elimination of drugs that are associated with kidney disease?
A. Reductions in plasma proteins increase the amount ofabirb.com/test
free drug and decrease the
amount of protein-bound drug.
B. Acute tubular necrosis is associated with impaired drug reabsorption through the
tubular epithelium.
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C. Decreased retention by the kidneys often renders normal
drug dosages
ineffective.
D. Dialysis removes active metabolites from circulation, thereby minimizing
therapeutic effect.
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Answer: A
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Rationale: A decrease in plasma proteins, particularly albumin,
that occurs in many
persons with renal failure results in less protein-bound drug and greater amounts of
free drug. Drug elimination problems do not stem as directly from impaired tubular
reabsorption, decreased retention, or the process of dialysis.
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Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
Client Needs: Physiological Integrity: Pharmacological and
Parenteral Therapies
abirb.com/test
Reference: p. 901
15. An adult diagnosed with renal failure secondary to diabetes mellitus is
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scheduled to begin dialysis soon. Which statement by the
client reflects an accurate
understanding of the process of hemodialysis?
A. "It is stressful knowing that committing to dialysis means I cannot qualify for a
kidney transplant."
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B. "I know I will have to go to a hospital or dialysis center for treatment."
C. "Changing my schedule to accommodate 3 or 4 hours of hemodialysis each day
will be difficult."
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D. "I will not be able to go about my normal routine during
treatment."
Answer: D
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Rationale: Hemodialysis requires the client to remain connected to dialysis
machinery, whereas peritoneal dialysis allows for activity during treatment. Dialysis
does not disqualify an individual from receiving a transplant. Dialysis does not
require attendance at a dialysis center; clients can be taught
to perform the dialysis
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WWW.THENURSINGMASTERY.COM
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in their home with a family member in attendance. Hemodialysis is normally
conducted 3 times weekly, not once per day.
Question format: Multiple Choice
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 896
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16. Which clinical finding among older adults is most likely to be viewed as a
normal part of age-related changes?
A. 81-year-old client whose serum creatinine level has increased
abirb.com/test sharply since the
last blood work
B. 78-year-old client whose glomerular filtration rate (GFR) has been steadily
declining over several years
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C. 90-year-old client whose blood urea nitrogen (BUN) is
rising
D. 80-year-old cliet whose dipstick urine reveals protein is present
Answer: B
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Rationale: A gradual decrease in GFR is considered a normal age-related change.
Sudden increase in creatinine or BUN would warrant follow up, as would the
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presence of protein in a client's urine.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
abirb.com/test
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 905
17. A client with hypertension, arthritis, and early chronic
kidney disease (CKD) has
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developed viral gastroenteritis and is unable to consume adequate fluids. Which
prescribed medications should the nurse caution the client about taking due to the
increased risk for prerenal acute kidney injury? Select all that apply.
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A. Ramipril
B. Ibuprofen
C. Acetaminophen
D. Amlodipine
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E. Calcium carbonate
F. Hydrochlorothiazide
Answer: A, B, F
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Rationale: While at risk for dehydration, the client should be cautioned against
taking medications that can either worsen dehydration or interfere with renal blood
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flow autoregulation. Hydrochlorothiazide, a diuretic, will promote dehydration and
reduce renal blood flow. Ramipril, an angiotensin-converting enzyme inhibitor, may
cause prerenal acute kidney injury in persons with decreased blood flow due to
interference with efferent arteriole vasoconstriction. Ibuprofen,
an NSAID, can
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reduce renal blood flow through inhibition of prostaglandin synthesis, which
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WWW.THENURSINGMASTERY.COM
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prevents afferent arteriole vasodilation. Acetaminophen is not an NSAID and does
not interfere with renal blood flow. Calcium carbonate is an antacid and poses no
risk. Amlodipine is a calcium channel blocker that is not linked to pre-renal acute
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kidney injury, but if the client's blood pressure were low,
this medication may need
to be avoided while the client is ill.
Question format: Multiple Select
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
abirb.com/test
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Reference: p. 901
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18. A client is admitted to the hospital with acute kidney injury (AKI). Which
diagnostic test will the nurse assess to best determine the cause of the AKI?
A. Glomerular filtration rate
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B. Creatinine level
C. Blood urea nitrogen (BUN) or urea
D. BUN:creatinine or urea:creatinine ratio
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Answer: D
Rationale: Creatinine, urea/BUN, and glomerular filtration rate may all be abnormal
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in AKI, so alone these results do not offer as much information
about the cause of
AKI as examining the elevation of urea/BUN in comparison to creatinine (known as
the BUN:Cr ratio). In causes that are pre-renal, the BUN:Cr ratio will exceed 20:1
(Ur:Cr greater than 100:1), which helps the heath care provider differentiate the
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pre-renal from intra-renal causes of AKI.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
abirb.com/test
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 894
19. The nurse is planning the care for a client with acuteabirb.com/test
kidney injury (AKI). What
should the nurse prioritize in the client's plan of care? Select all that apply.
A. Assessing fluid balance
B. Monitoring electrolyte levels
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C. Promoting infection control
D. Optimizing pain control
E. Protecting from falls
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Answer: A, B, C
Rationale: The nurse will need to monitor fluid balance carefully as the client can
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experience both fluid volume excess and deficit in AKI. There are also serious
consequences due to electrolyte imbalances, such as cardiac dysrhythmias related
to hyperkalemia. Secondary infections are a major cause of death in people with
AKI, making infection control another priority. Having AKI
on its own does not
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increase the risk for falls or cause pain in the client.
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WWW.THENURSINGMASTERY.COM
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Question format: Multiple Select
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Apply
abirb.com/test
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 891
20. The nurse is caring for a group of four male clients with chronic kidney disease
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(CKD) and coronary artery disease. The nurse will prioritize which client as being
at greatest risk for angina?
A. The client with electrocardiogram results indicating sinus bradycardia
B. The client with a hemoglobin level of 8.0 g/dL (80 g/L)
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C. The client with a calcium level of 8 mg/dL (2.0 mmol/L)
D. The client with a blood pressure of 160/90 mm Hg
Answer: B
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Rationale: A hemoglobin level of 8.0 g/dL (80 g/L) is significantly lower than the
normal lower limit for males of 14.0 g/dL (140 g/L). Thisabirb.com/test
reduction in oxygencarrying capacity places the client at risk for myocardial ischemia. A mildly lower
calcium level does not directly create an imbalance in myocardial oxygen supply
and demand. Bradycardia reduces myocardial oxygen demand while increasing
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supply, compared to tachycardia that can result as a compensatory
mechanism in
anemia. The elevated blood pressure would not result in angina.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
abirb.com/test
Cognitive Level: Analyze
Client Needs: Safe, Effective Care Environment: Management of Care
Reference: p. 899
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21. A 5-year-old child who had been receiving dialysis treatments has undergone
renal transplant and will now be taking prednisone. The parents are hopeful the
child's development and overall health will normalize. The nurse should inform the
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parents that taking prednisone can result in some similar
adverse effects as living
with chronic kidney disease (CKD). Which effects should the nurse include? Select
all that apply.
A. Fluid retention
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B. Increased risk for infection
C. Delayed growth
D. Weakened bone structure
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E. Hypokalemia
F. Increased blood glucose
Answer: A, B, C, D
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Rationale: Of the effects listed, those that are common to CKD and taking a
corticosteroid medication include fluid retention, growth delays, weakening of bone
structure, and increased risk for infection. Although reasons
behind these effects
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differ between CKD and corticosteroid use, the results are similar in varying
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WWW.THENURSINGMASTERY.COM
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degrees. Although a corticosteroid can also cause hypokalemia and increased blood
glucose levels, these are not effects of CKD.
Question format: Multiple Select
abirb.com/test
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Reference: p. 893
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22. The nurse is caring for an older adult client with acute glomerulonephritis who
develops sudden-onset dyspnea. The client's vital signs are: blood pressure 175/96
mm Hg; heart rate 98 bpm; respiratory rate 22 breaths/min;
oxygen saturation
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88% on room air. What is the nurse's priority assessment?
A. Breath sounds
B. Electrocardiogram
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C. Urine appearance and volume
D. Level of consciousness
Answer: A
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Rationale: Given the client's report of dyspnea and low oxygen saturation level,
breath sounds should be assessed to determine evidence of pulmonary edema. This
immediate bedside assessment should be done prior to abirb.com/test
any of the others listed,
because it offers the best evidence related to a time-sensitive, likely, and lifethreatening complication of acute kidney injury in the older adult. All the other
assessments are relevant and can be done once breath sounds are assessed.
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Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Reduction of Risk Potential
abirb.com/test
Reference: p. 892
23. The nurse is monitoring a group of clients being treated for various chronic
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illnesses. Which clients should the nurse prioritize as most
at risk for
hyperkalemia? Select all that apply.
A. 80-year-old with left-sided heart failure taking a loop diuretic
B. 76-year-old with type 2 diabetes controlled with insulin
and taking an ACE
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inhibitor
C. 25-year-old with acute kidney injury taking penicillin
D. 65-year-old with rheumatoid arthritis taking a corticosteroid
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E. 55-year-old with Addison disease taking a mineralocorticoid
Answer: B, C
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Rationale: The balance of serum potassium is highly dependent on renal excretion,
which is directly affected by the glomerular filtration rate (GFR); the excretion and
reabsorption in the tubules is dependent on the amount of aldosterone present
(i.e., the more aldosterone present, the more potassiumabirb.com/test
will be excreted in urine).
The client with type 2 diabetes may have a decreased GFR and taking an ACE
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WWW.THENURSINGMASTERY.COM
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inhibitor reduces the action of aldosterone, both increasing the risk for
hyperkalemia. Though only 25 years old, having acute kidney injury means this
client has a decreased GFR and thus will be at high risk for hyperkalemia. While
Addison disease can cause hyperkalemia, the treatmentabirb.com/test
with a mineralocorticoid
will increase the loss of potassium in urine, correcting the hyperkalemia. The client
with rheumatoid arthritis will also have higher levels of aldosterone activity due to
the use of corticosteroids, reducing potassium levels. The client on a loop diuretic is
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at risk for hypokalemia.
Question format: Multiple Select
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
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Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 858
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24. A client is in cardiogenic shock following a massive myocardial
client's family asks the nurse, "Why are the health care providers recommending
dialysis since its the heart that is sick?" Which response by the nurse is most
appropriate at this time?
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A. "It looks like your loved one has been exposed to nephrotoxic drugs like a
nonsteroidal anti-inflammatory drug (NSAID) prior to the heart attack."
B. "When a person has such a large heart attack, the kidneys suffer by developing
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clots which interfere with urine production."
C. "When a person has a large heart attack and goes into shock due to heart
failure, there is a decrease in renal perfusion which allows toxins to increase in the
blood."
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D. "It looks like your family member has had a blockage in the ureters for quite
some time and the heart attack has made it more difficult for the blood to be
filtered by the kidney."
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Answer: C
Rationale: Prerenal acute kidney injury (AKI) is characterized by a marked decrease
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in renal blood flow. It is reversible if the cause of the decreased
renal blood flow
can be identified and corrected before kidney damage occurs. Causes of prerenal
AKI include heart failure and cardiogenic shock. This would call for temporary
dialysis to filter the blood while the heart is healing. Intrarenal
AKI is caused by
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acute tubular necrosis due to exposure to nephrotoxic drugs or prolonged ischemia.
Postrenal AKI is caused by bilateral ureteral obstruction.
Question format: Multiple Choice
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Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Physiological Adaptation
Reference: p. 900
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25. A nurse is caring for a group of clients and reviewing the recent laboratory
values and medical charts. What adult client(s) is exhibiting early manifestations of
prerenal acute kidney injury (AKI), which should be reported
to the health care
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provider? Select all that apply.
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A. Urine output has dropped from 1200 mL/24 hours to current 300 mL/24 hours.
B. Hemoglobin has dropped from 13.4 g/dL to 12.0 g/dL (134 to 120 g/L).
C. Blood urea nitrogen (BUN) to creatinine ratio has gone from 10:1 to 21:1.
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D. Glomerular filtration rate (GFR) is currently 93.
E. Serum creatinine level has increased from 0.6 to 1.2 mg/dL (53 to 106 μmol/L).
Answer: A, C
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Rationale: Prerenal AKI is manifested by a sharp decrease in urine output such as
300 mL/24 hours and a disproportionate elevaltion of BUN in relation to serum
creatinine levels. A normal value is 10:1, but a value of abirb.com/test
21:1 is a disporportionate
elevation in the ratio. The hemoglobin level of 12.0 g/dL (120 g/L) is on the low
end of normal for adults. For adults in their 50s, a GFR of 93 is normal. Serum
creatinine levels are normal from 0.6 to 1.2 mg/dL (53 to 106 μmol/L).
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Question format: Multiple Select
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
Client Needs: Physiological Integrity: Physiological Adaptation
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Reference: p. 892
26. A client in the intensive care unit is receiving a blood transfusion. The client
immediately developed a reddish-color urine flowing intoabirb.com/test
the Foley bag. What is
likely the cause of this red urine and what priority intervention should the nurse
implement?
A. Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be
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stopped immediately.
B. Myoglobinuria causes urine color change and is associated with muscle
destruction; call the health care provider immediately.
C. Trauma to the urethra can cause blood in the urine; increase
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increasing IV flow rate.
D. Exposure to bacteria causing urinary tract infeciton with bleeding; contact health
care provider for antibiotic prescription.
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Answer: A
Rationale: The onset of red urine during or shortly after abirb.com/test
a blood transfusion may
represent hemoglobinuria indicating an acute hemolytic reaction. The priority of the
nurse is to stop the transfusion, then call the laboratory and the health care
provider. Myoglobinuria causes urine color change, usually brown in color, and is
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associated with muscle destruction. There is no indication
that this occurred
recently but if it occurs, the health care provider should be notified. Trauma with
insertion of a catheter would cause bleeding at the time of the insertion and would
not be associated with a blood transfusion. Severe kidney infections can cause
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bleeding but this would have been evident prior to hanging/infusing the blood.
Question format: Multiple Choice
Chapter 34: Acute Kidney Injury and Chronic Kidney Disease
Cognitive Level: Analyze
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Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
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WWW.THENURSINGMASTERY.COM
Reference: p. 893
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