Chapter 47: Acute and Chronic Kidney

Question 1

Risk

Answer 1

Serum creatinine increased × 1.5
OR
GFR decreased by 25%

Urine output
<0.5 mL/kg/hr
for 6 hr

Question 2

Injury

Answer 2

Serum creatinine increased × 2
OR
GFR decreased by 50%

Urine output
<0.5 mL/kg/hr
for 12 hr

Question 3

Failure

Answer 3

Serum creatinine increased × 3
OR
GFR decreased by 75%
OR
Serum creatinine >4 mg/dL with
acute rise ≥0.5 mg/dL

Urine output
<0.3 mL/kg/hr
for 24 hr
(oliguria)
OR
Anuria for 12 hr

Question 4

Loss

Answer 4

Persistent acute kidney failure;
complete loss of kidney
function >4 wk

Question 5

End-stage
kidney
disease

Answer 5

Complete loss of kidney function

>3 mo

Question 6

Nonoliguria AKI indicates a urine output

Answer 6

greater than

400 mL/day

Question 7

a urinalysis may show

Answer 7

specific gravity fixed at around 1.010 and urine osmolality at
about 300 mOsm/kg (300 mmol/kg)

Question 8

Fluid overload

can eventually lead to

Answer 8

HF, pulmonary edema, and pericardial

and pleural effusions.

Question 9

Uncontrolled

hyponatremia or water excess

Answer 9

can lead to cerebral edema

Question 10

The best serum indicator of AKI

Answer 10

creatinine

Question 11

Asterixis

Answer 11

(flapping tremor when the wrist is extended)
is most common with liver failure, but has been known to occur
with advanced and severe kidney dysfunction.

Question 12

During the diuretic phase of AKI, daily

urine output is usually around

Answer 12

1 to 3 L, but may reach 5 L or
more.
caused by osmotic diuresis

Question 13

The recovery phase begins when the

Answer 13

GFR
increases, allowing the BUN and serum creatinine levels to
plateau and then decrease

Question 14

Urine sediment

containing abundant cells, casts, or proteins suggests

Answer 14

intrarenal disorders

Question 15

kidney ultrasound

Answer 15

first test done, since it provides
imaging without exposure to potentially nephrotoxic contrast
agents.

Question 16

A primary nutritional goal in AKI

is to maintain adequate caloric intake

Answer 16

(providing 30 to 35 kcal/
kg and 0.8 to 1.0 g of protein per kilogram of desired body
weight) to prevent the further breakdown of body protein for
energy purposes. (diet consists of carbs and fat sources and supplements of essential amino acids.)

Question 17

Nursing diagnoses and a potential complication for the patient
with AKI (examples-NANDA) p1106

Answer 17

• Excess fluid volume related to kidney failure and fluid
retention
• Risk for infection related to invasive lines, uremic toxins,
and altered immune responses secondary to kidney failure
• Fatigue related to anemia, metabolic acidosis, and uremic
toxins
• Anxiety related to disease processes, therapeutic interventions,
and uncertainty of prognosis
• Potential complication: dysrhythmias related to electrolyte
imbalances

Question 18

infection is the leading cause of death in AKI

Answer 18

meticulous

aseptic technique is critical

Question 19

The Kidney Disease Outcomes
Quality Initiative (KDOQI) of the National Kidney Foundation
defines CKD as either the

Answer 19

presence of kidney damage or a
decreased GFR less than 60 mL/min/1.73 m2 for longer than 3
months.

Question 20

end-stage kidney (renal)

disease (ESKD), occurs when

Answer 20

GFR is less than 15 mL/min.
At this point, RRT (dialysis or transplantation) is required to
maintain life

Question 21

Stage 1

Answer 21

Kidney damage
with normal or
↑ GFR
≥90
Diagnosis and treatment
CVD risk reduction
Slow progression

Question 22

Stage 2

Answer 22

Kidney damage
with mild ↓ GFR
60-89
Estimation of progression

Question 23

Stage 3

Answer 23

Moderate ↓ GFR
30-59
Evaluation and treatment of
complications

Question 24

Stage 4

Answer 24

Severe ↓ GFR
15-29
Preparation for renal
replacement therapy
(dialysis, kidney transplant

Question 25

Stage 5

Answer 25

Kidney failure
<15 (or dialysis)
Renal replacement therapy
(if uremia present and
patient desires treatment)

Question 26

Uremia

Answer 26

is a syndrome in which kidney function
declines to the point that symptoms may develop in multiple
body systems
occurs when GFR is
10 mL/min or less

Question 27

ACI….. As the GFR decreases

Answer 27

the

BUN and serum creatinine levels increase

Question 28

insulin depends on the kidneys for excretion

Answer 28

remains in circulation
longer.

Mild to moderate hyperglycemia and hyperinsulinemia may
occur.

Question 29

The altered lipid

metabolism is related to

Answer 29

decreased levels of the enzyme lipoprotein
lipase, which is important in the breakdown of lipoproteins

hyperlipidemia

Question 30

Sodium intake must be

individually determined but is generally

Answer 30

restricted to 2 g/day.

Question 31

hormone produced by the kidney

Answer 31

erythropoietin

Question 32

two

equations used most frequently to estimate GFR are the

Answer 32

Cockcroft-Gault formula and the Modification of Diet in Renal
Disease (MDRD)

Question 33

Cockcroft-Gault GFR =

Answer 33

(140 − Age) × (Weight in kilograms) × (0.85 if female)/(72 × Cr).

Question 34

A focus on stages 1 through 4 before the need for dialysis, stage 5

Answer 34

includes the control of hypertension,

hyperparathyroid disease, anemia, hyperglycemia, and dyslipidemia.

Question 35

Never give sodium polystyrene sulfonate to a patient

Answer 35

with a hypoactive bowel (paralytic ileus) because fluid shifts
could lead to bowel necrosis.

Question 36

recommended

that the target BP be

Answer 36

less than 130/80 mm Hg for patients with

CKD and 125/75 mm Hg for patients with significant proteinuria

Question 37

a total parathyroidectomy

Answer 37

some parathyroid
tissue is transplanted into the forearm. The transplanted
cells produce PTH as needed.

Question 38

Nursing diagnoses for CKD may include, but are not limited to,
the following:

Answer 38

• Risk for electrolyte imbalance related to impaired kidney
function resulting in hyperkalemia, hypocalcemia, hyperphosphatemia,
and altered vitamin D metabolism
• Imbalanced nutrition: less than body requirements related
to restricted intake of nutrients (especially protein),
nausea, vomiting, anorexia, and stomatitis

Question 39

Instruct the patient to avoid certain over-the-counter

drugs such as

Answer 39

NSAIDs and aluminum- and magnesium-based

laxatives and antacids.

Question 40

advantages of PD peritoneal dialysis

Answer 40

• Immediate initiation in
almost any hospital
• Less complicated than
hemodialysis
• Portable system with CAPD
• Fewer dietary restrictions
• Relatively short training
time
• Usable in patient with
vascular access problems
• Less cardiovascular stress
• Home dialysis possible
• Preferable for diabetic
patient

Question 41

disadvantages of PD

Answer 41

• Bacterial or chemical peritonitis
• Protein loss into dialysate
• Exit site and tunnel infections
• Self-image problems with catheter
placement
• Hyperglycemia
• Surgery for catheter placement
• Contraindicated in patient with
multiple abdominal surgeries,
trauma, unrepaired hernia
• Requires completion of education
program
• Catheter can migrate
• Best instituted with willing partner

Question 42

advantages of HD hemodialysis

Answer 42

• Rapid fluid removal
• Rapid removal of urea and
creatinine
• Effective potassium
removal
• Less protein loss
• Lowering of serum
triglycerides
• Home dialysis possible
• Temporary access can be
placed at bedside

Question 43

disadvantages of HD

Answer 43

• Vascular access problems
• Dietary and fluid restrictions
• Heparinization may be necessary
• Extensive equipment necessary
• Hypotension during dialysis
• Added blood loss that contributes
to anemia
• Specially trained personnel
necessary
• Surgery for permanent access
placement
• Self-image problems with
permanent access

Question 44

To perform HD,

Answer 44

a very rapid blood flow is

required, and access to a large blood vessel is essential

Question 45

HD high risk for

Answer 45

air ebolus

Question 46

PD more easier done at

Answer 46

home than HD

Question 47

PD takes a

Answer 47

loner time than HD

Question 48

HD has an increased risk for

Answer 48

hep B & C

Question 49

AV GRAFT… description

Answer 49

synthetic tubing tunneled beneath the skin connecting an artery and vein

Question 50

AV shunt

Answer 50

external loop of synthetic tubing connecting an artery and vein

Question 51

AV fistula

Answer 51

internal surgical anastomsis between an artery and a vein

Question 52

thrill

Answer 52

buzzing sensation indicates graft is patent

Question 53

When caring for a patient during the oliguric phase of acute kidney injury (AKI), what is an appropriate nursing intervention?

Answer 53

Patients in the oliguric phase of acute kidney injury will have fluid volume excess with potassium and sodium retention. Therefore they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 ml for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.

Question 54

The patient was diagnosed with prerenal AKI. The nurse should know that what is most likely the cause of the patient's diagnosis?
  IV tobramycin (Nebcin)
  Incompatible blood transfusion
  Poststreptococcal glomerulonephritis
  Dissecting abdominal aortic aneurysm

Answer 54

A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and poststretpcoccal glomerulonephritis are intrarenal causes of AKI.

Question 55

The nurse knows the patient with AKI has entered the diuretic phase when what assessments occur

Answer 55

Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Therefore the serum BUN and serum creatinine levels also begin to decrease.

Question 56

Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. The nurse should know that ultrafiltration in peritoneal dialysis is achieved by which method?

Answer 56

Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

Question 57

Continuous venovenous hemofiltration (CVVH)

Answer 57

CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection