AKI (chapter 16)

Question 1

1. With sudden cessation of renal function, all body systems are affected by the inability to maintain fluid and electrolyte balance and eliminate metabolic waste. In critically ill patients, renal dysfunction:
   a. is a very rare problem.
   b. affects nearly two thirds of patients.
   c. has a low mortality once renal replacement therapy has been initiated.
   d. has little effect on morbidity, mortality, or quality of life.

Answer 1

b. affects nearly two thirds of patients.

Question 2

2. The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is evaluating the patients urinalysis results. The nurse should become concerned when
   a. creatinine levels in the urine are similar to blood levels of creatinine.
   b. sodium and chloride are found in the urine.
   c. urine uric acid levels have the same values as serum levels.
   d. red blood cells and albumin are found in the urine

Answer 2

d. red blood cells and albumin are found in the urine

Question 3

3. A normal glomerular filtration rate is:
A. less than 80 mL/min. 
B. 80 to 125 mL/min
C. 125 to 180 mL/min 
D.more than 189 mL/min

Answer 3

B. 80 to 125 mL/min

Question 4

A normal urine output is considered to be:
A. 80 to 125 mL/min. 
B.180 L/day.
C.80 mL/min.
D.1 to 2 L/day

Answer 4

1 to 2 L/day

Question 5

Renin plays a role in blood pressure regulation by:

a. activating the renin-angiotensin-aldosterone cascade.
b. suppressing angiotensin production.
c. decreasing sodium reabsorption.
d. inhibiting aldosterone release.

Answer 5

a. activating the renin-angiotensin-aldosterone cascade.

Question 6

The nurse is caring for an elderly patient who was admitted with renal insufficiency. The nurse realizes that with advance age often comes declining renal function. An expected laboratory finding for this patient may be:

a. an increased glomerular filtration rate (GFR).
b. a normal serum creatinine level.
c. increased ability to excrete drugs.
d. hypokalemia.

Answer 6

b. a normal serum creatinine level.

Question 7

7. The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is:
A. oliguria.
B. azotemia.
C. acute kidney injury. 
D. prerenal disease

Answer 7

B. azotemia.

Question 8

The most common cause of acute kidney injury in critically ill patients is:
A. sepsis.
B. fluid overload. 
C.medications. 
D.hemodynamic instability

Answer 8

A. Sepsis

Question 9

The nurse is caring for a patient who has undergone major abdominal surgery. The nurse notices that the patients urine output has been less than 20 mL/hour for the past 2 hours. It is 0200 in the morning. The patients blood pressure is 100/60 mm Hg, and the pulse is 110 beats per minute. Previously, the pulse was 90 beats per minute with a blood pressure of 120/80 mm Hg. The nurse should:

a. contact the provider and expect an order for a normal saline bolus.
b. wait until 0900 when the provider makes rounds to report the assessment findings.
c. continue to evaluate urine output for 2 more hours.
d. ignore the urine output, as this is most likely postrenal in origin.

Answer 9

a. contact the provider and expect an order for a normal saline bolus.

Question 10

Acute kidney injury from post renal etiology is caused by:

a. obstruction of the flow of urine.
b. conditions that interfere with renal perfusion.
c. hypovolemia or decreased cardiac output.
d. conditions that act directly on functioning kidney tissue.

Answer 10

a. obstruction of the flow of urine.

Question 11

Conditions that produce acute kidney injury by directly acting on functioning kidney tissue are classified as intrarenal. The most common intrarenal condition is:

a. prolonged ischemia.
b. exposure to nephrotoxic substances.
c. acute tubular necrosis (ATN).
d. hypotension for several hours.

Answer 11

c. acute tubular necrosis (ATN).

Question 12

The patient undergoes a cardiac catheterization that requires the use of contrast dyes during the procedure. To detect signs of contrast-induced kidney injury, the nurse should:

a. not be concerned unless urine output decreases.
b. evaluate the patients serum creatinine for up to 72 hours after the procedure.
c. obtain an order for a renal ultrasound.
d. evaluate the patients post void residual volume to detect intrarenal injury.

Answer 12

b. evaluate the patients serum creatinine for up to 72 hours after the procedure.

Question 13

The nurse is caring for a patient with acute kidney injury who is being treated with hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the following would be the best response?

a. Unfortunately, kidney injury is not reversible; it is permanent.
b. Kidney function usually returns within 2 weeks.
c. You will know for sure if you start urinating a lot all at once.
d. recovery is possible, but it may take several months.

Answer 13

d. recovery is possible, but it may take several months.

Question 14

Which of the following patients is at the greatest risk of developing acute kidney injury? A patient who:

a. has been on aminoglycosides for the past 6 days.
b. has a history of controlled hypertension with a blood pressure of 138/88 mm Hg.
c. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks.
d. has a history of fluid overload as a result of heart failure.

Answer 14

c. was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks.

Question 15

. The patient has elevated blood urea nitrogen (BUN) and serum creatinine levels with a normal BUN/creatinine ratio. These levels most likely indicate:

a. increased nitrogen intake.
b. acute kidney injury, such as acute tubular necrosis (ATN).
c. hypovolemia.
d. fluid resuscitation.

Answer 15

b. acute kidney injury, such as acute tubular necrosis (ATN).

Question 16

The patients serum creatinine level is 0.7 mg/dL. The expected BUN level should be:

a. 1-2 mg/dL.
b. 7-14 mg/dL.
c. 10-20 mg/dL.
d. 20-30 mg/dL.

Answer 16

b. 7-14 mg/dL.

Question 17

In determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine is obtained. If a reliable 24-hour urine collection is not possible,

a. it is not possible to determine the GFR.
b. the BUN may be used to determine renal function.
c. an elevated BUN/creatinine ratio can be used.
d. a standardized formula may be used to calculate GFR.

Answer 17

d. a standardized formula may be used to calculate GFR.

Question 18

In calculating the glomerular filtration rate (GFR) results for women, the creatinine clearance is usually:

a. the same as for men.
b. greater than that for men.
c. multiplied by 0.85.
d. multiplied by 1.15.

Answer 18

c. multiplied by 0.85.

Question 19

The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patients urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has:

a. acute kidney injury from a prerenal condition.
b. acute kidney injury from postrenal obstruction.
c. intrarenal disease, probably acute tubular necrosis.
d. a urinary tract infection.

Answer 19

c. intrarenal disease, probably acute tubular necrosis.

Question 20

The patient is complaining of severe flank pain when he tries to urinate. His urinalysis shows sediment and crystals along with a few bacteria. Using this information along with the clinical picture, the nurse realizes that the patients condition is:

a. prerenal.
b. postrenal.
c. intrarenal.
d. not renal related.

Answer 20

b. postrenal.

Question 21

The patient is a new postoperative patient. She weighs 75 kg. The nurse expects the minimal acceptable urine output to be:

a. less than 30 mL/hour.
b. 37 mL/hour.
c. 80 mL/hour.
d. 150 mL/hour.

Answer 21

b. 37 mL/hour

Question 22

Daily weights are being recorded for the patient. His urine output has been less than his intravenous and oral intake. His weight yesterday was 97.5 kg. This morning it is 99 kg. The nurse understands that this corresponds to a(n):

a. fluid retention of 1.5 liters.
b. fluid loss of 1.5 liters.
c. equal intake and output due to insensible losses.
d. fluid loss of 0.5 liters.

Answer 22

a. fluid retention of 1.5 liters.

Question 23

The patient is admitted to the unit with the diagnosis of rhabdomyolysis. The patient is started on intravenous (IV) fluids and IV mannitol. Because mannitol is an osmotic diuretic, the nurse should:

a. assess the patients hearing.
b. assess the patients lungs.
c. decrease IV fluids once the diuretic has been administered.
d. give extra doses prior to giving radiological contrast agents.

Answer 23

b. assess the patients lungs

Question 24

The patient gets hemodialysis 3 days a week. He is 74 inches tall and weighs 100 kg. In planning the care for this patient, the nurse recommends:

a. 2500 to 3500 kcal diet per day.
b. protein intake less than 50 grams per day.
c. potassium intake of 10 mEq per day.
d. fluid intake of less than 500 mL per day.

Answer 24

a. 2500 to 3500 kcal diet per day.

Question 25

The patients potassium level is 7.0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?

a. Kayexalate
b. Kayexalate with sorbitol
c. Regular insulin
d. Calcium gluconate

Answer 25

a. Kayexalate

Question 26

. The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas is ordered and shows that the patients pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to:

a. administer morphine to slow the respiratory rate.
b. prepare for intubation and mechanical ventilation.
c. administer intravenous sodium bicarbonate.
d. cancel tomorrows dialysis session

Answer 26

c. administer intravenous sodium bicarbonate.

Question 27

The removal of plasma water and some lowmolecular weight particles by using a pressure or osmotic gradient is known as:

a. dialysis.
b. diffusion.
c. clearance.
d. ultrafiltration.

Answer 27

d. ultrafiltration

Question 28

The patient is in need of immediate hemodialysis, but has no vascular access. The nurse prepares the patient for insertion of:

a. a percutaneous catheter at the bedside.
b. a percutaneous tunneled catheter at the bedside.
c. an arteriovenous fistula.
d. an arteriovenous graft.

Answer 28

a. a percutaneous catheter at the bedside.

Question 29

The patient has a temporary percutaneous catheter in place for treatment of acute kidney injury. The catheter has been in place for 5 days. The nurse should:

a. prepare to assist with a routine dialysis catheter change to replace the existing catheter.
b. evaluate the patient for signs and symptoms of infection.
c. teach the patient that the catheter is designed for long-term use.
d. use one of the three lumens for fluid administration.

Answer 29

b. evaluate the patient for signs and symptoms of infection

Question 30

The patient has just returned from having an arteriovenous fistula placed. The patient asks, When will they be able to use this and take this other catheter out? The nurse should reply,

a. It can be used immediately so the catheter can come out anytime.
b. It will take 2 to 4 weeks to heal before it can be used.
c. The fistula will be usable in about 4 to 6 weeks.
d. The fistula was made using graft material so it depends on the manufacturer.

Answer 30

c. The fistula will be usable in about 4 to 6 weeks.

Question 31

The patient is in progressive care unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, the nurse should:

a. draw blood from the left arm.
b. take blood pressures from the left arm.
c. start a new intravenous line in the left lower arm.
d. auscultate the left arm for a bruit and palpate for a thrill.

Answer 31

d. auscultate the left arm for a bruit and palpate for a thrill.

Question 32

The nurse is assessing a patient with a new arteriovenous fistula, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable. The nurse should:

a. reassess the patient in an hour.
b. raise the arm above the level of the patients heart.
c. notify the provider immediately.
d. apply warm packs to the fistula site and reassess.

Answer 32

c. notify the provider immediately.

Question 33

The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in place. In caring for this patient, the nurse should:

a. apply a sterile gauze dressing to maintain sterility.
b. replace the transparent dressing every 10 days to prevent manipulation.
c. assess the catheter site for redness and/or swelling.
d. use the catheter for drawing blood samples to reduce patient discomfort.

Answer 33

c. assess the catheter site for redness and/or swelling

Question 34

The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of:

a. dialyzer membrane incompatibility.
b. a shift in potassium levels.
c. dialysis disequilibrium syndrome.
d. hypothermia.

Answer 34

c. dialysis disequilibrium syndrome.

Question 35

Continuous renal replacement therapy (CRRT) differs from conventional intermittent hemodialysis in that:

a. a hemofilter is used to facilitate ultrafiltration.
b. it provides faster removal of solute and water.
c. it does not allow diffusion to occur.
d. the process removes solutes and water slowly.

Answer 35

d. the process removes solutes and water slowly.

Question 36

Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used to:

a. remove plasma water in cases of volume overload.
b. remove fluids and solutes through the process of convection.
c. remove plasma water and solutes by adding dialysate.
d. combine ultrafiltration, convection and dialysis.

Answer 36

a. remove plasma water in cases of volume overload.

Question 37

Continuous venovenous hemofiltration is used to:

a. remove fluids and solutes through the process of convection.
b. remove plasma water in cases of volume overload.
c. remove plasma water and solutes by adding dialysate.
d. combine ultrafiltration, convection and dialysis.

Answer 37

a. remove fluids and solutes through the process of convection.

Question 38

Continuous venovenous hemodialysis is used to:

a. remove fluids and solutes through the process of convection.
b. remove plasma water in cases of volume overload.
c. remove plasma water and solutes by adding dialysate.
d. combine ultrafiltration, convection and dialysis

Answer 38

c. remove plasma water and solutes by adding dialysate

Question 39

The critical care nurse is responsible for monitoring the patient receiving continuous renal replacement therapy (CRRT). In doing so, the nurse should:

a. assess that the blood tubing is warm to the touch.
b. assess the hemofilter every 6 hours for clotting.
c. cover the dialysis lines to protect them from light.
d. use clean technique during vascular access dressing changes.

Answer 39

a. assess that the blood tubing is warm to the touch.

Question 40

Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis:

a. is more frequently used for acute kidney injury.
b. uses the patients own semipermeable membrane (peritoneal membrane).
c. is not useful in cases of drug overdose or electrolyte imbalance.
d. is not indicated in cases of water intoxication.

Answer 40

b. uses the patients own semipermeable membrane (peritoneal membrane).

Question 41

An advantage of peritoneal dialysis is that:

a. peritoneal dialysis is time intensive.
b. a decreased risk of peritonitis exists.
c. biochemical disturbances are corrected rapidly.
d. the danger of hemorrhage is minimal.

Answer 41

d. the danger of hemorrhage is minimal.

Question 42

The nurse is caring for a patient receiving peritoneal dialysis. The patient suddenly complains of abdominal pain and chills. The patients temperature is elevated. The nurse should:

a. assess peritoneal dialysate return.
b. check the patients blood sugar.
c. evaluate the patients neurological status.
d. inform the provider of probable visceral perforation.

Answer 42

a. assess peritoneal dialysate return.

Question 43

The patient is on intake and output (I&O) as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should:

a. draw a trough level after the next dose of antibiotic.
b. obtain an order to place the patient on fluid restriction.
c. assess the patients lungs.
d. insert an indwelling catheter.

Answer 43

c. assess the patients lungs.

Question 44

The patient has been admitted to the hospital with nausea and vomiting that started 5 days earlier. His blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; he has not voided in 8 hours and his bladder is not distended. The nurse anticipates an order for stat administration of:

a. a blood transfusion.
b. fluid replacement with 0.45% saline.
c. infusion of an inotropic agent.
d. an antiemetic.

Answer 44

b. fluid replacement with 0.45% saline.

Question 45

Identify which substances would indicate a problem with renal function. (Select all that apply).

a. protein.
b. sodium.
c. creatinine.
d. red blood cells.
e. uric acid.

Answer 45

a. protein.
d. red blood cells.
e. uric acid

Question 46

The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include: (Select all that apply.)

a. bladder catheterization.
b. increasing fluid volume intake.
c. ureteral stenting.
d. placement of nephrostomy tubes.
e. increasing cardiac output.

Answer 46

a. bladder catheterization.
c. ureteral stenting.
d. placement of nephrostomy tubes.

Question 47

Noninvasive diagnostic procedures used to determine kidney function include which of the following?
(Select all that apply.)
a. Kidney, ureter, bladder (KUB) x-ray
b. Renal ultrasound
c. Magnetic resonance imaging (MRI)
 d. Intravenous pyelography (IVP)
e. Renal angiography

Answer 47

a. Kidney, ureter, bladder (KUB) x-ray
b. Renal ultrasound
c. Magnetic resonance imaging (MRI)

Question 48

The most common reasons for initiating dialysis in acute kidney injury include which of the following?
(Select all that apply.)
a. Acidosis
b. Hypokalemia
c. Volume overload
d. Hyperkalemia
e. Uremia

Answer 48

a. Acidosis
c. Volume overload
d. Hyperkalemia
e. Uremia

Question 49

Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.)

a. Hypotension
b. Dysrhythmias
c. Muscle cramps
d. Hemolysis
e. Air embolism

Answer 49

a. Hypotension

b. Dysrhythmias

Question 50

The patient is in the critical care unit and will receive dialysis this morning. The nurse will: (Select all that apply.)

a. evaluate morning laboratory results and report abnormal results.
b. administer the patients antihypertensive medications.
c. assess the dialysis access site and report abnormalities.
d. weigh the patient to monitor fluid status.
e. give all medications except for antihypertensive medications.

Answer 50

a. evaluate morning laboratory results and report abnormal results.
c. assess the dialysis access site and report abnormalities.
d. weigh the patient to monitor fluid status.