renal emergencies

Question 1

A 20-year-old male presents with an acute onset of severe testicular pain. He denies any trauma to the genital region. He is conscious and alert, his blood pressure is 144/84 mm Hg, his heart rate is 120 beats/min, and his respirations are 24 breaths/min with adequate depth. The MOST important aspect in the care of this patient involves:
A) prompt transport.
B) narcotic analgesia.
C) IV fluid therapy.
D) high-flow oxygen.

Answer 1

A) prompt transport.

Question 2

All of the following conditions may cause urinary retention, EXCEPT:
A) testicular torsion.
B) nerve damage.
C) urinary tract infections.
D) benign prostatic hypertrophy.

Answer 2

A) testicular torsion.

Question 3

A 50-year-old man presents with a painful penile erection that has persisted for the past several hours. He is conscious but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation?
A) Renal failure
B) Head trauma
C) Cocaine abuse
D) Nitroglycerin use

Answer 3

C) Cocaine abuse

Question 4

A patient with prerenal acute renal failure would MOST likely present with:
A) confusion and hypertension.
B) joint pain and bladder distention.
C) hypotension and tachycardia.
D) peripheral edema and hematuria.

Answer 4

C) hypotension and tachycardia.

Question 5

Most cases of chronic renal failure are caused by:
A) systemic diseases such as diabetes.
B) nephron deterioration due to aging.
C) frequent lower urinary tract infections.
D) nephron destruction due to medications.

Answer 5

A) systemic diseases such as diabetes.

Question 6

The skin of a patient with chronic renal failure is MOST often:
A) flushed.
B) jaundiced.
C) cyanotic.
D) cool and dry.

Answer 6

B) jaundiced.

Question 7

Patients with chronic renal failure may present with uremic frost, especially:
A) in the urine.
B) during emesis.
C) to the flank area.
D) around the face.

Answer 7

D) around the face.

Question 8

Clinical manifestations of chronic renal failure include all of the following, EXCEPT:
A) dehydration.
B) hyperkalemia.
C) hypotension.
D) QT prolongation.

Answer 8

A) dehydration.

Question 9

A 59-year-old woman with chronic renal failure presents with an acute onset of dyspnea while undergoing hemodialysis treatment. She is conscious but in obvious respiratory distress. Further assessment reveals perioral cyanosis and a blood pressure of 96/56 mm Hg. Based on this patient’s medical history and clinical presentation, which of the following interventions is likely NOT indicated?
A) IV crystalloid fluid boluses
B) Left lateral recumbent position
C) Rapid transport to the hospital
D) Ventilation assistance as needed

Answer 9

A) IV crystalloid fluid boluses

Question 10

Which of the following statements regarding postrenal acute renal failure (ARF) is correct?
A) Patients with postrenal ARF typically develop severe hypokalemia.
B) Postrenal ARF involves damage to the renal parenchyma or tubules.
C) Postrenal ARF typically results in decreased pressure on the nephrons.
D) Postrenal ARF is caused by obstruction of urine flow from the kidneys.

Answer 10

D) Postrenal ARF is caused by obstruction of urine flow from the kidneys.

Question 11

Unlike peritoneal dialysis, hemodialysis:
A) is associated with a higher risk of peritonitis.
B) filters nitrogenous waste products from the blood.
C) involves the circulation of blood through a machine.
D) is only used for patients experiencing acute renal failure.

Answer 11

C) involves the circulation of blood through a machine.

Question 12

Which of the following statements regarding peritoneal dialysis is correct?
A) Because of the high risk of peritonitis, peritoneal dialysis can only be performed in a hospital or specialized dialysis center.
B) In peritoneal dialysis, large amounts of specially formulated dialysis fluid are infused into the abdominal cavity and left for 1 to 2 hours.
C) Peritoneal dialysis involves the surgical placement of an arteriovenous shunt in the vasculature of the abdominal cavity.
D) Peritoneal dialysis is the least preferred method of dialyzing a patient and is only used in extreme emergency situations.

Answer 12

B) In peritoneal dialysis, large amounts of specially formulated dialysis fluid are infused into the abdominal cavity and left for 1 to 2 hours.

Question 13

Unlike peritoneal dialysis, hemodialysis:
A) is associated with a higher risk of peritonitis.
B) filters nitrogenous waste products from the blood.
C) involves the circulation of blood through a machine.
D) is only used for patients experiencing acute renal failure.

Answer 13

C) involves the circulation of blood through a machine.

Question 14

A small, button-shaped device with a rubber septum that can be punctured with a dialysis needle is called a(n):
A) HemaSite.
B) Thomas’s shunt.
C) Scribner shunt.
D) internal shunt.

Answer 14

A) HemaSite.

Question 15

Patients requiring chronic dialysis:
A) are typically not able to ambulate.
B) are usually dialyzed every 2 or 3 days.
C) are almost always inpatients in a hospital.
D) stay on the dialysis machine for 6 to 8 hours.

Answer 15

B) are usually dialyzed every 2 or 3 days.

Question 16

Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of:
A) hypovolemia.
B) hypokalemia.
C) hyperkalemia.
D) air embolism.

Answer 16

B) hypokalemia.

Question 17

Which of the following is a potentially life-threatening complication of missing one or more dialysis treatments?
A) Uremic frost
B) Hyperkalemia
C) Hypocalcemia
D) Peripheral edema

Answer 17

B) Hyperkalemia

Question 18

You are dispatched to a residence for an elderly man with an altered mental status. As you are assessing the patient, his wife tells you that he goes to dialysis several times a week, but has missed his last three treatments because their car broke down. The patient’s skin is yellow, his blood pressure is 98/60 mm Hg, and his pulse rate is 118 beats/min. The ECG reveals sinus tachycardia with peaked T waves. You should be MOST concerned with the potential for:
A) severe hypovolemia.
B) acute bradycardia or heart block.
C) lethal ventricular dysrhythmias.
D) hypokalemia-induced cardiac arrest.

Answer 18

C) lethal ventricular dysrhythmias.

Question 19

You receive a call to a residence for a 60-year-old man who is bleeding from his dialysis shunt. When you arrive, the patient’s wife, who has been properly trained on the use of the dialysis machine, tells you that she panicked and called EMS. The dialysis cannula has loosened from the needle, which is still in the shunt. Your initial action should be to:
A) immediately clamp off the cannula and apply direct pressure.
B) attempt to tighten the connection between the needle and cannula.
C) remove the dialysis needle from the shunt and apply direct pressure.
D) apply direct pressure over the shunt and carefully remove the needle.

Answer 19

B) attempt to tighten the connection between the needle and cannula.

Question 20

Immediately following a dialysis treatment, a middle-aged woman complains of generalized weakness and nausea. Her blood pressure is 80/50 mm Hg, pulse rate is 40 beats/min and weak, and respirations are 22 breaths/min and regular. She is receiving supplemental oxygen, and an IV line has been established in the extremity opposite the shunt. The ECG reveals sinus bradycardia in lead II. Your next action should be to:
A) obtain a 12-lead ECG tracing.
B) administer 0.5 mg of atropine sulfate.
C) administer a 20-mL/kg fluid bolus.
D) administer calcium and bicarbonate.

Answer 20

B) administer 0.5 mg of atropine sulfate.

Question 21

A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, has a pulse rate of 90 beats/min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should:
A) recognize that she probably received an overaggressive dialysis treatment.
B) start an IV line with normal saline and infuse 200 mL of normal saline per hour.
C) transport at once, start an IV line en route and give nitroglycerin to lower her blood pressure. D) monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.

Answer 21

D) monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.