Exam 3 Flashcards
AKI, CKI,
Which clinical manifestation(s) leads the nurse to suspect the client with kidney injury is developing uremia? Select all that apply.
A. weakness and fatigue
B. lethargy and confusion
C. extreme itching
D. blood in urine
E. urine smell in the stool
A, B, C, D
Uremia affects all body systems. The symptoms at the onset include weakness, fatigue, nausea, and apathy. These are subtle signs. More severe symptoms include extreme weakness, frequent vomiting, lethargy, and confusion. Pruritus often accompanies the uremic state as well. The term uremia literally means “urine in the blood”; however, it does not cause the appearance of blood in urine (hematuria). There is no direct effect on the gastrointestinal system, so the smell of stool does not change.
Many drugs and other nephrotoxic agents can induce nephrotic acute tubular necrosis (ATN). The nurse knows that these agents cause tubular injury by which mechanisms? Select all that apply.
A, Renal vasoconstriction
B. Hyponatremia
C. Intratubular obstruction
D. Renal vasodilation
E. Direct tubular damage
A, C, E
Drugs and other nephrotoxic agents induce ATN via renal vasoconstriction, direct damage, or obstruction. Renal vasodilation and hyponatremia are not direct causes of ATN
An 86-year-old client has been admitted to the hospital for the treatment of dehydration and hyponatremia after they curtailed their fluid intake to minimize urinary incontinence. The client’s admitting laboratory results are suggestive of prerenal kidney failure. The nurse should be assessing this client for which early sign of prerenal kidney injury?
A. sharp decrease in urine output
B. excessive voiding of clear urine
C. acute hypertensive crisis
D. intermittent periods of confusion
A. sharp decrease in urine output
Dehydration and its consequent hypovolemia can result in acute kidney injury that is prerenal in etiology. The kidney normally responds to a decrease in glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Postrenal kidney injury is obstructive in etiology, and intrinsic (or intrarenal) kidney injury is reflective of deficits in the function of the kidneys themselves.
A client diagnosed with acute kidney injury (AKI) has a serum potassium level of 6.5 mEq/L. The nurse anticipates administering:
A. sodium polystyrene sulfonate (Kayexalate)
B. Sorbitol
C. IV dextrose 50%
D. Calcium supplements
A. sodium polystyrene sulfonate (Kayexalate)
The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract. Sorbitol may be administered in combination with Kayexalate to induce a diarrhea-type effect (it induces water loss in the GI tract). If the client is hemodynamically unstable (low blood pressure, changes in mental status, dysrhythmia), IV dextrose 50%, insulin, and calcium replacement may be administered to shift potassium back into the cells.
The nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
A. Hypernatremia.
B. Hypokalemia.
C. Hyperkalemia.
D. Hypercalcemia.
C. Hyperkalemia
Hyperkalemia is a common complication of acute renal failure. It is life-threatening if immediate action isn’t taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels. Hypernatremia, hypokalemia, and hypercalcemia don’t usually occur with acute renal failure and aren’t treated with glucose, insulin, or sodium bicarbonate.
The nurse expects which of the following assessment findings in the client in the diuretic phase of acute renal failure?
A. Dehydration
B. Hyperkalemia
C. Crackles
D. Hypertension
A. Dehydration
The diuretic phase of acute renal failure is characterized by increased urine output, hypotension, and dehydration.
When acute tubular necrosis (ATN) is suspected, the nurse will likely see which laboratory findings on the urinalysis report? Select all that apply.
A. Protein
B. Glucose
C. Red blood cells
D. Sodium excess
E. Cast cells
A, C, E
Nephron damage allows the larger protein cells to pass through the membrane and into the urine (normally, urine has very few proteins present). Further diagnostic information that can be obtained from the urinalysis includes hemoglobinuria (blood in the urine) and casts or crystals in the urine. Glucosuria in the urine is an indirect indication of extreme hyperglycemia, often unrelated to renal disease. Urine sodium concentration is maintained with prerenal azotemia; urine sodium decreases with renal tubule damage. Urine calcium is not diagnostic for ATN.
Which client does the nurse need to monitor for the development of intense intrarenal vasoconstriction that may induce prerenal failure? Select all that apply.
A. Client undergoing cardiac catheterization
B. Client taking acetaminophen for fever
C. Client taking cyclosporine to prevent rejection for a liver transplant
D. Client who is HIV positive
E. Client with an elevated blood urea nitrogen who is taking ibuprofen every 6 hours for back pain
A, C, E
Some vasoactive mediators, drugs, and diagnostic agents stimulate intense intrarenal vasoconstriction and can induce glomerular hypoperfusion and prerenal failure. Examples include endotoxins, radiocontrast agents such as those used for cardiac catheterization, cyclosporine, and nonsteroidal anti-inflammatory drugs. NSAIDs can reduce renal blood flow by inhibiting prostaglandin syntheses. In some persons with diminished renal perfusion, NSAIDs can precipitate prerenal failure. Acetaminophen for short-term use does not predispose a client to prerenal failure. An HIV+ client is at no more risk than any other client.
A home care nurse is visiting a client with acute kidney injury who is on fluid restriction. The client tells the nurse, “I get thirsty very often. What might help?” What would the nurse include as a suggestion for this client?
A. Avoid salty or excessively sweet fluids.
B. Use regular gum and hard candy. C. Eat crackers and bread.
D. Use an alcohol-based mouthwash to moisten your mouth.
A. Avoid salty or excessively sweet fluids.
To minimize thirst in a client on fluid restriction, the nurse should suggest the avoidance of salty or excessively sweet fluids. Gum and hard candy may temporarily relieve thirst by drawing fluid into the oral cavity because the sugar content increases oral tonicity. Fifteen to 30 minutes later, however, oral membranes may be even drier than before. Dry foods, such as crackers and bread, may increase the client’s feeling of thirst. Allowing the client to rinse the mouth frequently may decrease thirst, but this should be done with water, not alcohol-based, mouthwashes, which would have a drying effect.
The nurse is caring for a client who has had acute blood loss from ruptured esophageal varices. What does the nurse recognize is an early sign of prerenal kidney injury?
A. baseline blood pressure of 150/90 mm Hg that is now 130/80 mm Hg
B. baseline heart rate of 100 beats/min that has increased to 120 beats/min
C. baseline urine output of 50 ml/hr that is now 10 mlk/hr
D. foul-smelling, cloudy urine
C. baseline urine output of 50 ml/hr that is now 10 mlk/hr
The kidneys normally respond to a decrease in the glomerular filtration rate with a decrease in urine output. Thus, an early sign of prerenal kidney injury is a sharp decrease in urine output.
The nurse is preparing to assess a client who has just been admitted to the hospital with a diagnosis of prerenal failure. Which would the nurse expect the client to manifest? Select all that apply.
A. Decreased urinary output
B. Increased BUN BUN-to-serum creatinine ratio of greater than 20:1
C. Increased urinary output
D. Decreased BUN
E. BUN to serum creatinine ratio of 10:1
A, B
Prerenal injury is manifested by a sharp decrease in urine output and a disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine levels. Consequently, there also is a disproportionate elevation in the ratio of BUN to serum creatinine, from a normal value of 10:1 to a ratio greater than 20:1.
The nurse is caring for a client with acute renal failure and edema. Which actions should the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply.
A. Administer furosemide orally twice a day.
B. Make sure the urinal is within the client’s reach.
C. Assess breath sounds.
D. Remind the client that all urine is to be saved for intake and output measurement.
E. Weigh the client every morning using the standing scale.
F. Measure and record vital signs.
B, D, E, F
A 35-year-old ultramarathon runner is admitted to the hospital following a day-long, 50-mile race because their urinary volume is drastically decreased and urine is dark red. Tests indicate that they are in the initiating phase of acute tubular necrosis. Why is the client’s urine red?
A. hematuria
B. hemoglobinuria
C. myoglobinuria
D. kidney bleeding
C. myoglobinuria
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 exercise and muscle trauma can contribute. Although both hemoglobinuria and myoglobinuria discolor the urine, hemoglobinuria results from hemolysis following a reaction to a blood transfusion, whereas myoglobinuria involves muscle damage.
A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis disequilibrium syndrome, a complication that’s most common during the first few dialysis sessions. Typically, dialysis disequilibrium syndrome causes:
A. confusion, headache, and seizures.
B. acute bone pain and confusion.
C. weakness, tingling, and cardiac arrhythmias.
D. hypotension, tachycardia, and tachypnea.
A. confusion, headache, and seizures.
Dialysis disequilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.
What is a characteristic of the intrarenal category of acute kidney injury (AKI)?
A. Decreased creatinine
B. Increased BUN
C. High specific gravity
D. Decreased urine sodium
B. Increased BUN
Hyperkalemia is a serious side effect of acute renal failure. Identify the electrocardiogram (ECG) tracing that is diagnostic for hyperkalemia.
A. Tall, peaked T waves
B. Shortened QRS complex
C. Multiple spiked P waves
D. Prolonged ST segment
A. Tall, peaked T waves
Characteristic ECG signs of hyperkalemia are tall, tented, or peaked T waves, absent P waves, and a widened QRS complex.
What is used to decrease potassium level seen in acute renal failure?
A. Sodium polystyrene sulfonate
B. Sorbitol
C. IV dextrose 50%
D. Calcium supplements
A. Sodium polystyrene sulfonate
The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
The nurse is providing care to a child with acute kidney injury. What assessment is priority for the nurse to determine if this child is developing hyperkalemia?
A. pulse rate and rhythm
B. muscle tone
C. blood pressure
D. abdominal pain
A. pulse rate and rhythm
Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.
Which client(s) scheduled for an interventional radiology procedure requiring administration of radiocontrast dye is considered high risk for nephrotoxicity? Select all that apply.
A. 14-year-old client with severe abdominal pain
B. 25-year-old client with a history of glomerular nephritis who is reporting severe flank pain
C. 67-year-old client with diabetes undergoing diagnostic testing for new-onset proteinuria
D. 45-year-old client with elevated liver enzymes possibly due to fatty liver cirrhosis
E. 53-year-old client undergoing biopsy for a suspicious “spot” on a chest x-ray
B and C
Radiocontrast media-induced nephrotoxicity is thought to result from direct tubular toxicity and renal ischemia. The risk for kidney injury caused by radiocontrast media is greatest in older adults and those with preexisting kidney disease, volume depletion, diabetes, and recent exposure to other nephrotoxic agents.
The nurse is caring for a 6-year-old client diagnosed with acute kidney injury. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescription(s) will the nurse anticipate from the primary health care provider? Select all that apply.
A. furosemide
B. dialysis
C. serum electrolyte levels
D. urinalysis
E. labetalol
A, B, C, D, E
Which medication does the nurse anticipate being prescribed for the client with kidney injury who has hyperphosphatemia?
A. vitamin D
B. calcium carbonate
C. levothyroxine
D. cinacalcet
B. calcium carbonate
Phosphate-binding antacids (aluminum salts, calcium carbonate, or calcium acetate) may be prescribed to decrease the absorption of phosphate from the gastrointestinal tract.
A client with acute renal failure has the following laboratory results. Based on these findings, which of the following should the nurse administer? hemoglobin 9.2 g/dL, blood urea nitrogen 22 mg/dL, creatinine 0.7 mg/dL, potassium 4.8 mEq/L
A. calcium gluconate
B. potassium chloride
C. furosemide
D. erythropoietin
D. erythropoietin
Erythropoietin assists in the production of red blood cells, which are low as evidenced by the hemoglobin level. All other laboratory values are within normal limits.
Which clinical finding among older adult clients is likely to be viewed as a normal part of age-related changes?
A. 81-year-old client whose serum creatinine level has increased sharply since the last blood work
B. 78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years
C. 90-year-old client whose blood urea nitrogen (BUN) is rising
D. 80-year-old client whose dipstick urine reveals protein is present
B. 78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years
A gradual decrease in glomerular filtration rate (GFR) is considered a normal age-related change. A sudden increase in creatinine or blood urea nitrogen (BUN) would warrant follow-up, as would the presence of protein in a client’s urine.
