NURS 317 Unit 1 Chapter 34 Path Point Questions Flashcards
A student asks the nurse preceptor about a laboratory test called interleukin (IL)-18. Which statement by the nurse will assist the student in providing better care to clients with acute kidney injuries (AKI)?
A) “This is one of the biomarkers which can help differentiate inflammation versus carcinoma in the kidney.”
B) “This is one of the new markers which helps confirm whether the kidney is trying to internally kill its own cells.”
C) “This is an inflammatory cytokine which is an early marker for ischemic AKI in the proximal tubule.”
D) “This helps with the differentiation of kidney injury versus a rheumatic disease that is affecting the kidney.”
C) “This is an inflammatory cytokine which is an early marker for ischemic AKI in the proximal tubule.”
Rationale:Some new biomarkers for assessing AKI earlier than conventional parameters include IL-18. It is produced in the proximal tubule after AKI and is an inflammatory cytokine. This marker increases with ischemic AKI and is easily measured in the urine. IL-18 does not confirm carcinoma in the kidney or rheumatic disease. It also does not help confirm whether the kidney is trying to internally self-mutilate its own cells.
A client with a diagnosis of end-stage renal disease received a kidney transplant 2 years ago that was deemed a success. During the most recent follow-up appointment, the nurse should prioritize the client for referral based on which statement?
A) “I’m feeling a bit under the weather these days and I’m a bit feverish.”
B) “I’ve noticed that my urine is a bit more concentrated than usual the last few days.”
C) “I’ve decided to try eating less fat and carbohydrates than I have been.”
D) “The scarring on my flank where the surgery was done doesn’t seem to be fading.”
A) “I’m feeling a bit under the weather these days and I’m a bit feverish
Rationale:Clients who are taking immunosuppressants after a transplant are susceptible to infections, which require prompt treatment. Concentrated urine is not a sign of a problem and persistent scarring is inconsequential. Minor changes to diet should be assessed, but are not necessarily contraindicated.
A client is diagnosed with chronic kidney disease (CKD). The nurse will monitor for which manifestations of this disorder? Select all that apply.
A) Osteodystrophy
B) Anemia
C) Right ventricular dysfunction
D) Hypercalcemia
E) Increased nitrogenous waste in blood
A) Osteodystrophy
B) Anemia
E) Increased nitrogenous waste in blood
Rationale:There are numerous manifestations of CKD. Blood urea nitrogen (BUN) rises as nitrogenous waste is not removed from the circulatory system. Anemia occurs as the renal production of erythropoietin declines. Abnormal resorption and remodeling of bone occurs. Blood levels of calcium fall as the kidneys lose the ability to excrete phosphate and to convert inactive vitamin D to its active form. Left ventricular dysfunction occurs as extracellular fluid, including blood, volume increases. Anemia fosters left ventricular hypertrophy.
A child is diagnosed with chronic kidney disease (CKD). The nurse knows that which statements regarding supportive renal therapy in children are true? Select all that apply.
A) Children older than 12 years will benefit from hemodialysis.
B) Peritoneal dialysis is generally most appropriate for children younger than 6.
C) Corticosteroid therapy reduces the risk of growth retardation in children.
D) Less immune system suppression is needed in children than in adults.
E) Early transplantation is the preferred treatment when considering long-term effects.
A) Children older than 12 years will benefit from hemodialysis.
B) Peritoneal dialysis is generally most appropriate for children younger than 6.
E) Early transplantation is the preferred treatment when considering long-term effects.
Rationale:Children between birth and 5 years of age often are managed with peritoneal dialysis. For those older than 12 years of age hemodialysis is usually preferred. Early transplantation in young children is the best choice to promote physical growth, improve cognitive function, and foster psychosocial development. Immunosuppressive therapy in children is similar to that required in adults. Corticosteroids such as prednisone have risk for growth retardation.
A child has received a kidney transplant at the age of 3. Knowing he will be on immunosuppressive agents like corticosteroids, the nurse should educate the parents about which long-term side effects? Select all that apply.
A) Hypertension
B) Frequent hematuria
C) Growth retardation
D) Development of cataracts
E) Excess weight loss
A) Hypertension
C) Growth retardation
D) Development of cataracts
Rationale:Early transplantation in young children is regarded as the best way to promote physical growth, improve cognitive function, and foster psychosocial development. Immunosuppressive therapy in children is similar to that used in adults. All immunosuppressive agents have side effects, including increased risk for infection. Corticosteroids carry the risk for hypertension, orthopedic complications (especially aseptic necrosis), cataracts, and growth retardation. Steroids usually are associated with weight gain. Frequent hematuria is caused by something other than steroids and should be reported.
The nurse is educating a client with chronic kidney disease (CKD). What is the recommended daily fluid intake for this client?
A) Intake equal to daily urine output to maintain hydration
B) A minimum of 2000 mL/day to flush out the kidneys
C) A daily fluid intake of 500 to 800 mL/day to maintain hydration
D) No oral intake of fluids
C) A daily fluid intake of 500 to 800 mL/day to maintain hydration
Rationale:Daily fluid intake of 500 to 800 mL/day will replace insensible water loss plus a quantity equal to the 24-hour urine output. Intake of 2000 mL will exceed the renal ability to excrete water and will lead to circulatory overload and edema
When educating a group of nursing students about the primary causes of chronic kidney disease (CKD) in Western societies, the nurse asks, “What do you think are the main causes of CKD in adults?” Which student answer(s) is deemed correct? Select all that apply.
A) Substance use disorder
B) Autoimmune diseases
C) Alcohol use disorder
D) Hypertension
E) Diabetes mellitus
D) Hypertension
E) Diabetes mellitus
Rationale:Hypertension and diabetic kidney disease are the two main causes of CKD in Western societies. It is not autoimmune disease, subtance use disorder, or alcohol use disorder.
The nurse caring for a group of clients should monitor which clients for the development of intrarenal failure? Select all that apply.
A) Client with a gastrointestinal hemorrhage
B) Client with lead poisoning
C) Client taking gentamicin for the treatment of a kidney infection
D) Client with septic shock from pneumonia
E) Client with acute glomerulonephritis
B) Client with lead poisoning
C) Client taking gentamicin for the treatment of a kidney infection
D) Client with septic shock from pneumonia
E) Client with acute glomerulonephritis
Rationale:Causes of intrarenal kidney injury are acute tubular necrosis/acute renal injury; prolonged renal ischemia; exposure to nephrotoxic drugs such as gentamicin, heavy metals, and organic solvents; intratubular obstruction resulting from hemoglobinuria, myoglobinuria, myeloma light chains, uric acid casts, and acute renal disease (e.g., acute glomerulenephritis, pyelonephritis).
Which dermatologic problem most often accompanies chronic kidney disease (CKD)?
A) Alopecia and fungal rashes
B) Hirsutism and psoriasis
C) Dry skin and pruritus
D) Petechiae and purpura
C) Dry skin and pruritus
Rationale:Dry, itchy skin is a common consequence of CKD. Petechiae, purpura, hirsutism, psoriasis, alopecia, and fungal rashes are not noted to accompany or result from CKD.
The health care provider has prescribed an aminoglycoside (gentamicin) for a client. The nurse is aware that the client is at risk for:
A) Nephrotoxic acute tubular necrosis
B) Chronic kidney disease
C) Ischemic acute tubular necrosis
D) Postrenal failure
A) Nephrotoxic acute tubular necrosis
Rationale:Pharmacologic agents that are directly toxic to the renal tubule include aminoglycosides (e.g., gentamicin), chemotherapeutic agents such as cystplastin and ifosfamide, and radiocontrast agents. Nephrotoxic agents cause tubular injury by inducing varying combinations of renal vasoconstriction, direct tubular damage, or intratubular obstruction. Postrenal failure results from obstruction of outflow of the kidneys. CKD and its treatment can interfere with the absorption, distribution, and elimination of drugs. Acute tubular necrosis (ATN) occurs most frequently in clients who have major trauma, severe hypovolemia, overwhelming sepsis, trauma, or burns.
A client with chronic kidney disease (CKD) is anemic. The nurse will attempt to alleviate the anemia in order to prevent which of the following? Select all that apply.
A) Decreased myocardial oxygen
B) Fatigue
C) Hypersomnia
D) Tachycardia
E) Increased blood viscosity
A) Decreased myocardial oxygen
B) Fatigue
D) Tachycardia
Rationale:Uncorrected anemia provokes fatigue and insomnia, a decrease in blood viscosity, a decrease in myocardial oxygen supply, and tachycardia as the heart attempts to supply sufficient oxygen to the heart and brain.
A client has prerenal failure. The nurse knows that this type of failure is characterized by which relationship of blood urea nitrogen (BUN) to serum creatinine levels?
A) A BUN to creatinine level ratio of 20:1
B) An elevated BUN level and decreased creatinine level
C) A BUN to creatinine level ratio of 10:1
D) An elevated creatinine level and decreased BUN level
A) A BUN to creatinine level ratio of 20:1
Rationale:In prerenal failure, glomerular filtration rate (GFR) decreases, allowing more filtered urea to be reabsorbed into the circulatory system. Creatinine is filtered but remains in the forming urine. Therefore, the BUN to creatinine ratio rises to 20:1. A ratio of 10:1 is normal.
A 35-year-old client is diagnosed with acute kidney injury (AKI) and is started on hemodialysis. The client is concerned with the diagnosis and wants to know what to expect in the progression of this disorder. Which statement best addresses the client’s concern?
A) “Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately.”
B) “Once your condition improves you can be placed on peritoneal dialysis for the rest of your life.”
C) “You will need to have a renal transplant to live a productive, healthy life.”
D) “The occurrence of acute kidney injury will always eventually result in chronic renal failure.”
A) “Acute kidney injury is abrupt in onset and often reversible if recognized early and treated appropriately.”
Rationale:AKI is the result of a rapid decline in kidney function that increases blood levels of nitrogenous wastes. Once the underlying cause is treated, AKI is potentially reversible if the precipitating factors can be corrected or removed before permanent damage occurs.
Which symptom occurs in a client with chronic kidney disease (CKD) as a result of elevated serum phosphate levels and the development of phosphate crystals that occur with hyperparathyroidism?
A) Azotemia
B) Uremia
C) Pruritus
D) Asterixis
C) Pruritus
Rationale:Pruritus is common in persons with CKD; it results from high phosphate levels and the development of phosphate crystals. Azotemia refers to elevated levels of nitrogenous wastes in the blood. Uremia is the accumulation of organic wastes in the blood. Asterixis, a sign of hepatic encephalopathy, is due to the inability of the liver to metabolize ammonia to urea.
A 45-year-old female is being treated for ovarian cancer. Her treatment involves the chemotherapy agent cisplatin. The nurse should monitor the client for signs and symptoms of:
A) anemia.
B) chronic renal failure (CRF).
C) glomerulonephritis.
D) nephrotoxic acute tubular necrosis (ATN).
D) nephrotoxic acute tubular necrosis (ATN).
Rationale:The development of nephrotoxic acute tubular necrosis is due to the concentration effect of the kidney. The prolonged exposure to the chemotherapy agent causes the ATN. The disease state would progress faster than the CRF, and the glomerulus would not be affected. Anemia is not related to this type of chemotherapy.
