Renal System Assessment and Acute Kidney Injury, Exams of Biology

Download Renal System Assessment and Acute Kidney Injury and more Exams Biology in PDF only on Docsity! SOLE Chapter 16: Acute Kidney Injury TEST BANK exam test with correct answers for the verified questions  The critical care nurse knows that in critically ill patients, renal dysfunction o is a very rare problem. o affects nearly two thirds of patients. o has a low mortality rate once renal replacement therapy has been initiated. o has little effect on morbidity, mortality, or quality of life. - Correct answer ANS: B  The kidney is the primary regulator of the body's internal environment. With sudden  cessation of renal function, all body systems are affected by the inability to maintain fluid  and electrolyte balance and eliminate metabolic waste. Renal dysfunction is a common  problem in critically ill patients, with nearly two thirds of patients experiencing some degree  of renal dysfunction. The most severe cases, requiring renal replacement therapy, have a  reported mortality rate of 50% to 60%. Acute kidney injury that progresses to chronic renal  failure is associated with increased morbidity, mortality, and reduced quality of life.  DIF: Cognitive Level: Remember/Knowledge REF: p. 417  OBJ: Review the anatomy and physiology of the renal system.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is  evaluating the patient's urinalysis results. The nurse should become concerned when o creatinine levels in the urine are similar to blood levels of creatinine. o sodium and chloride are found in the urine. o urine uric acid levels have the same values as serum levels. o red blood cells and albumin are found in the urine. - Correct answer ANS: D  Normal glomerular filtrate is basically protein free and contains electrolytes, including  sodium, chloride, and phosphate, and nitrogenous waste products, such as creatinine, urea,  and uric acid, in amounts similar to those in plasma. Red blood cells, albumin, and globulin  are too large to pass through the healthy glomerular membrane. Their presence in urine may  indicate glomerular damage.  DIF: Cognitive Level: Understand/Comprehension REF: p. 418  OBJ: Review the anatomy and physiology of the renal system.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  DIF: Cognitive Level: Remember/Knowledge REF: p. 418  OBJ: Review the anatomy and physiology of the renal system.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The nurse is caring for an elderly patient who was admitted with renal insufficiency. An  expected laboratory finding for this patient may be o an increased glomerular filtration rate (GFR). o a normal serum creatinine level. o increased ability to excrete drugs. o hypokalemia. - Correct answer ANS: B  The most important renal physiological change that occurs with aging is a decrease in the  GFR. After age 40, renal blood flow gradually diminishes at a rate of 10% per decade. With  advancing age, there is also a decrease in renal mass, the number of glomeruli and  peritubular density. Serum creatinine levels may remain the same in the elderly patient, even  with a declining GFR, because of decreased muscle mass and hence decreased creatinine  production. Tubular changes include a diminished ability to excrete drugs, including  radiocontrast dyes used in diagnostic testing, which necessitates a decrease in drug dosing to  avoid nephrotoxicity. Many medications, including antibiotics, require dose adjustments as  kidney function declines. Age-related changes in renin and aldosterone levels also occur,  which can lead to fluid and electrolyte abnormalities. Renin levels are decreased by 30% to  50% in the elderly, resulting in less angiotensin II production and lower aldosterone levels.  Together these can cause an increased risk of hyperkalemia. The aging kidney is also slower  to correct an increase in acids, causing a prolonged metabolic acidosis and the subsequent  shifting of potassium out of cells and worsening hyperkalemia.  DIF: Cognitive Level: Understand/Comprehension  REF: p. 423 Lifespan box  OBJ: Review the anatomy and physiology of the renal system.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is o oliguria. o azotemia. o acute kidney injury. o prerenal disease. - Correct answer ANS: B  Azotemia refers to increases in blood urea nitrogen and serum creatinine. Oliguria is defined  as urine output less than 0.5 mL/kg/hr. Elevation of BUN and creatinine can be the result of  acute kidney injury or chronic kidney diseases. Conditions that result in AKI by interfering  with renal perfusion are classified as prerenal.  DIF: Cognitive Level: Remember/Knowledge REF: p. 419  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The most common cause of acute kidney injury in critically ill patients is o sepsis. o fluid overload. o medications. o hemodynamic instability. - Correct answer ANS: A  The etiology of AKI in critically ill patients is often multifactorial and develops from a  combination of hypovolemia, sepsis, medications, and hemodynamic instability. Sepsis is  the most common cause of AKI.  DIF: Cognitive Level: Remember/Knowledge REF: p. 419  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The nurse is caring for a patient who has undergone major abdominal surgery. The nurse  notices that the patient's urine output has been less than 20 mL/hour for the past 2 hours.  The patient's blood pressure is 100/60 mm Hg, and the pulse is 110 beats/min. Previously,  the pulse was 90 beats/min with a blood pressure of 120/80 mm Hg. The nurse should  ischemia (prerenal), exposure to nephrotoxic substances, or a combination of these. Some  patients have ATN after only several minutes of hypotension or hypovolemia, whereas  others can tolerate hours of renal ischemia without having any apparent tubular damage.  DIF: Cognitive Level: Remember/Knowledge REF: p. 420  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  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 o not be concerned unless urine output decreases. o evaluate the patient's serum creatinine for up to 72 hours after the procedure. o obtain an order for a renal ultrasound. o evaluate the patient's postvoid residual volume to detect intrarenal injury. - Correct answer ANS: B  Contrast- induced kidney injury is diagnosed by an increase in serum creatinine of 25%, or  0.5 mg/dL, within 48 to 72 hours following the administration of contrast. Urine output  usually remains normal. The renal ultrasound and postvoid residual assessment are not  warranted.  DIF: Cognitive Level: Analyze/Analysis REF: p. 421  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  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? o "Unfortunately, kidney injury is not reversible; it is permanent." o "Kidney function usually returns within 2 weeks." o "You will know for sure if you start urinating a lot all at once." o "Recovery is possible, but it may take several months." - Correct answer ANS: D  Renal dysfunction is potentially reversible during the initiation phase. This phase spans  several hours to 2 days, during which time the normal renal processes begin to deteriorate,  but actual intrinsic renal damage has not yet occurred. During the maintenance phase,  intrinsic renal damage is established, and the GFR stabilizes at approximately 5 to 10  mL/min. This phase usually lasts 8 to 14 days, but it may last up to 11 months. The longer a  patient remains in this stage, the slower the recovery and the greater the chance of  permanent renal damage will be. The recovery phase is the period during which the renal  tissue recovers and repairs itself. A gradual increase in urine output and an improvement in  laboratory values occur. Recovery may take as long as 4 to 6 months.  DIF: Cognitive Level: Understand/Comprehension REF: pp. 421-422  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Which of the following patients is at the greatest risk of developing acute kidney injury? A  patient who o has been on aminoglycosides for the past 6 days o has a history of controlled hypertension with a blood pressure of 138/88 mm Hg o was discharged 2 weeks earlier after aminoglycoside therapy of 2 weeks o has a history of fluid overload as a result of heart failure - Correct answer ANS: C  Acute kidney injury can be caused by aminoglycoside nephrotoxicity, especially prolonged  use of the drug (more than 10 days). Symptoms of acute kidney injury are usually seen  about 1 to 2 weeks after exposure. Because of this delay, the patient must be questioned  about any recent medical therapy for which an aminoglycoside may have been prescribed.  The blood pressure of 138/88 mm Hg controlled by medication would not cause acute  kidney injury, nor would fluid overload from exacerbation of heart failure.  DIF: Cognitive Level: Analyze/Analysis REF: p. 424  The BUN level is not a reliable indicator of kidney function because the rate of protein  metabolism is not constant. An increased BUN/creatinine ratio is typically noted with  prerenal conditions, but does not provide an estimate of GFR.  DIF: Cognitive Level: Understand/Comprehension REF: p. 427  OBJ: Describe the methods for assessing the renal system, including physical assessment,  and interpretation of laboratory values and radiological diagnostic tests.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  In calculating the glomerular filtration rate (GFR) results for women, the creatinine  clearance is usually: o the same as for men. o greater than that for men. o multiplied by 0.85. o multiplied by 1.15. - Correct answer ANS: C  For women, the calculated result is multiplied by 0.85 to account for the smaller muscle  mass as compared to men.  DIF: Cognitive Level: Remember/Knowledge REF: p. 427  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The patient is admitted with complaints of general malaise and fatigue, along with a  decreased urinary output. The patient's urinalysis shows coarse, muddy brown granular  casts and hematuria. The nurse determines that the patient has: o acute kidney injury from a prerenal condition. o acute kidney injury from postrenal obstruction. o intrarenal disease, probably acute tubular necrosis. o a urinary tract infection. - Correct answer ANS: C  Analysis of urinary sediment and electrolyte levels is helpful in distinguishing among the  various causes of acute kidney injury. Coarse, muddy brown granular casts are classic  findings in ATN. Microscopic hematuria and a small amount of protein also may be seen. In  prerenal conditions, the urine typically has no cells but may contain hyaline casts. Postrenal  conditions may present with stones, crystals, sediment, bacteria, and clots from the  obstruction. Bacteria would be present in a urinary tract infection.  DIF: Cognitive Level: Analyze/Analysis REF: p. 427  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  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 patient's condition is o prerenal. o postrenal. o intrarenal. o not renal related. - Correct answer ANS: B  Analysis of urinary sediment and electrolyte levels is helpful in distinguishing among the  various causes of acute kidney injury. Postrenal conditions may present with stones,  crystals, sediment, bacteria, and clots from the obstruction. Coarse, muddy brown granular  casts are classic findings in ATN (intrarenal), along with microscopic hematuria and a small  amount of protein. In prerenal conditions, the urine typically has no cells but may contain  hyaline casts. The flank pain and urinalysis definitely indicate a renal condition.  DIF: Cognitive Level: Remember/Knowledge REF: p. 427  OBJ: Describe the methods for assessing the renal system, including physical assessment,  and interpretation of laboratory values and radiological diagnostic tests.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  What is a minimally acceptable urine output for a patient weighing 75 kg? o Less than 30 mL/hour o 37 mL/hour o 80 mL/hour o 150 mL/hour - Correct answer ANS: B o fluid intake of less than 500 mL per day. - Correct answer ANS: A  Nutritional recommendations include the following: caloric intake of 25 to 35 kcal/kg of  ideal body weight per day (2500 to 3500 kcal) and protein intake of no less than 0.8 g/kg  body weight. Patients who are extremely catabolic such as those on hemodialysis should  receive protein in the amount of 1.5 to 2 g/kg of ideal body weight per day, 75% to 80% of  which contains all the required essential amino acids; sodium intake of 0.5 to 1.0 g/day;  potassium intake of 20 to 50 mEq/day; calcium intake of 800 to 1200 mg/day; fluid intake  equal to the volume of the patient's urine output plus an additional 600 to 1000 mL/day.  DIF: Cognitive Level: Apply/Application REF: p. 431  OBJ: Develop a plan of care for the patient with acute kidney injury.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  The patient's 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? o Sodium polystyrene sulfonate o Sodium polystyrene sulfonate with sorbitol o Regular insulin o Calcium gluconate - Correct answer ANS: A  Only dialysis and administration of cation exchange resins (sodium polystyrene sulfonate)  actually reduce plasma potassium levels and total body potassium content in a patient with  renal dysfunction. In the past, sorbitol has been combined with sodium polystyrene  sulfonate powder for administration. The concomitant use of sorbitol with sodium  polystyrene sulfonate has been implicated in cases of colonic intestinal necrosis; therefore,  this combination is not recommended. Other treatments, such as administration of regular  insulin and calcium gluconate, "protect" the patient for only a short time until dialysis or  cation exchange resins can be instituted.  DIF: Cognitive Level: Remember/Knowledge REF: p. 432  OBJ: Describe the medical management of the patient with acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  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  shows that the patient's pH is 7.19, with a PCO2 of 30 mm Hg and a bicarbonate level of 13  mEq/L. The nurse prepares to o administer morphine to slow the respiratory rate. o prepare for intubation and mechanical ventilation. o administer intravenous sodium bicarbonate. o cancel tomorrow's dialysis session. - Correct answer ANS: C  Metabolic acidosis is the primary acid-base imbalance seen in acute kidney injury.  Treatment of metabolic acidosis depends on its severity. Patients with a serum bicarbonate  level of less than 15 mEq/L and a pH of less than 7.20 are usually treated with intravenous  sodium bicarbonate. The goal of treatment is to raise the pH to a value greater than 7.20.  Rapid correction of the acidosis should be avoided, because tetany may occur as a result of  hypocalcemia. Renal replacement therapies also may correct metabolic acidosis because it  removes excess hydrogen ions and bicarbonate is added to the dialysate and replacement  solutions; therefore, dialysis would not be canceled. The tachypnea is a compensatory  mechanism for the metabolic acidosis, and treatments to decrease the respiratory rate are not  indicated. Treatment is aimed at correcting the metabolic acidosis, and this scenario does  not provide data to support the need for intubation.  DIF: Cognitive Level: Analyze/Analysis REF: p. 432  OBJ: Describe the medical management of the patient with acute kidney injury.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  The removal of plasma water and some low- molecular weight particles by using a pressure  or osmotic gradient is known as o dialysis.  Routine replacement of hemodialysis catheters to prevent infection is not recommended.  The decision to remove or replace the catheter is based on clinical need and/or signs and  symptoms of infection. The typical catheter has a single or double lumen and is designed  only for short-term renal replacement therapy during acute situations. The catheter is not  used for fluid and medication administration.  DIF: Cognitive Level: Apply/Application REF: p. 434  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  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, o "It can be used immediately, so the catheter can come out anytime." o "It will take 2 to 4 weeks to heal before it can be used." o "The fistula will be usable in about 4 to 6 weeks." o "The fistula was made using graft material, so it depends on the manufacturer." - Correct answer ANS: C  An arteriovenous fistula is an internal, surgically created communication between an artery  and a vein. This method produces a vessel that is easy to cannulate but requires 4 to 6 weeks  before it is mature enough to use.  DIF: Cognitive Level: Understand/Comprehension REF: p. 434  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The patient is in a 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 o draw blood from the left arm. o take blood pressures from the left arm. o start a new intravenous line in the left lower arm. o auscultate the left arm for a bruit and palpate for a thrill. - Correct answer ANS: D  An arteriovenous fistula should be auscultated for a bruit and palpated for the presence of a  thrill or buzz every 8 hours. The extremity that has a fistula or graft must never be used for  drawing blood specimens, obtaining blood pressure measurements, administering  intravenous therapy, or giving intramuscular injections. Such activities produce pressure  changes within the altered vessels that could result in clotting or rupture.  DIF: Cognitive Level: Remember/Knowledge REF: p. 434  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  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 o reassess the patient in an hour. o raise the arm above the level of the patient's heart. o notify the provider immediately. o apply warm packs to the fistula site and reassess. - Correct answer ANS: C  Inadequate collateral circulation past the fistula or graft may result in loss of this pulse. The  physician is notified immediately if no bruit is auscultated, no thrill is palpated, or the distal  pulse is absent. Loss of bruit and thrill indicate a loss of blood flow, most likely due to  clotting. The patient will need to return to surgery as soon as possible for declotting. Raising  the arm above the level of the heart will not help. Warm packs may or may not help.  DIF: Cognitive Level: Apply/Application REF: pp. 434- 435  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Continuous renal replacement therapy (CRRT) differs from conventional intermittent  hemodialysis in that o a hemofilter is used to facilitate ultrafiltration. o it provides faster removal of solute and water. o it does not allow diffusion to occur. o the process removes solutes and water slowly. - Correct answer ANS: D  CRRT is a continuous extracorporeal blood purification system managed by the bedside  critical care nurse. It is similar to conventional intermittent hemodialysis in that a hemofilter  is used to facilitate the processes of ultrafiltration and diffusion. It differs in that CRRT  provides a slow removal of solutes and water as compared to the rapid removal of water and  solutes that occurs with intermittent hemodialysis.  DIF: Cognitive Level: Remember/Knowledge REF: p. 436  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used to o remove plasma water in cases of volume overload. o remove fluids and solutes through the process of convection. o remove plasma water and solutes by adding dialysate. o combine ultrafiltration, convection, and dialysis. - Correct answer ANS: A  Slow continuous ultrafiltration (SCUF) is also known as isolated ultrafiltration and is used  to remove plasma water in cases of volume overload. Continuous venovenous  hemofiltration (CVVH) is used to remove fluids and solutes through the process of  convection. Continuous venovenous hemodialysis (CVVHD) is similar to CVVH in that  ultrafiltration removes plasma water. It differs in that dialysate solution is added around the  hemofilter membranes to facilitate solute removal by the process of diffusion. Continuous  venovenous hemodiafiltration (CVVHDF) combines ultrafiltration, convection, and dialysis  to maximize fluid and solute removal.  DIF: Cognitive Level: Remember/Knowledge REF: p. 436  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Continuous venovenous hemofiltration is used to o remove fluids and solutes through the process of convection. o remove plasma water in cases of volume overload. o remove plasma water and solutes by adding dialysate. o combine ultrafiltration, convection, and dialysis. - Correct answer ANS: A  Continuous venovenous hemofiltration (CVVH) is used to remove fluids and solutes  through the process of convection. Slow continuous ultrafiltration (SCUF) is used to remove  plasma water in cases of volume overload. Continuous venovenous hemodialysis (CVVHD)  is similar to CVVH in that ultrafiltration removes plasma water. It differs in that dialysate  solution is added around the hemofilter membranes to facilitate solute removal by the  process of diffusion. Continuous venovenous hemodiafiltration (CVVHDF) combines  ultrafiltration, convection, and dialysis to maximize fluid and solute removal.  DIF: Cognitive Level: Remember/Knowledge REF: pp. 436-437  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Continuous venovenous hemodialysis is used to o remove fluids and solutes through the process of convection. o remove plasma water in cases of volume overload. o remove plasma water and solutes by adding dialysate.  semipermeable membrane (the peritoneal membrane) with a dialysate solution that has been  instilled into the peritoneal cavity. This renal replacement therapy is not commonly used for  the treatment of acute kidney injury because of its comparatively slow ability to alter  biochemical imbalances. Clinical indications for peritoneal dialysis include acute and  chronic kidney injury, severe water intoxication, electrolyte disorders, and drug overdose.  DIF: Cognitive Level: Remember/Knowledge REF: p. 438  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Analysis  MSC: NCLEX Client Needs Category: Physiological Integrity  An advantage of peritoneal dialysis is that o peritoneal dialysis is time intensive. o a decreased risk of peritonitis exists. o biochemical disturbances are corrected rapidly. o the danger of hemorrhage is minimal. - Correct answer ANS: D  Advantages of peritoneal dialysis include that the equipment is assembled easily and  rapidly, the cost is relatively inexpensive, the danger of acute electrolyte imbalances or  hemorrhage is minimal, and dialysate solutions can be individualized. In addition,  automated peritoneal dialysis systems are available. Disadvantages of peritoneal dialysis  include that it is time intensive, requiring at least 36 hours for a therapeutic effect to be  achieved; biochemical disturbances are corrected slowly; access to the peritoneal cavity is  sometimes difficult; and the risk of peritonitis is high.  DIF: Cognitive Level: Understand/Comprehension REF: p. 438  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Analysis  MSC: NCLEX Client Needs Category: Physiological Integrity  The nurse is caring for a patient receiving peritoneal dialysis. The patient suddenly  complains of abdominal pain and chills. The patient's temperature is elevated. The nurse  should o assess peritoneal dialysate return. o check the patient's blood sugar. o evaluate the patient's neurological status. o inform the provider of probable visceral perforation. - Correct answer ANS: A  Peritonitis is the most common complication of peritoneal dialysis therapy and is usually  caused by contamination in the system. Peritonitis is manifested by abdominal pain, cloudy  peritoneal fluid, fever and chills, nausea and vomiting, and difficulty in draining fluid from  the peritoneal cavity.  DIF: Cognitive Level: Apply/Application REF: p. 439  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  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 o draw a trough level after the next dose of antibiotic. o obtain an order to place the patient on fluid restriction. o assess the patient's lungs. o insert an indwelling catheter. - Correct answer ANS: C  The scenario indicates retention of fluid; therefore, the nurse must assess for symptoms of  fluid overload, for example, by auscultating the lung fields. Adequate hydration is essential  and fluid restriction would be determined by the provider upon physical examination and  analysis of laboratory results. An indwelling urinary catheter should not routinely be  inserted because it increases the risk of infection. A trough level is drawn just before the  next dose of a drug is given and is an indicator of how the body has cleared the drug; it  would not be done secondary to imbalanced intake and output.  DIF: Cognitive Level: Apply/Application REF: p. 439  OBJ: Describe the medical management of the patient with acute kidney injury.  TOP: Nursing Process Step: Implementation o increasing fluid volume intake. o ureteral stenting. o placement of nephrostomy tubes. o increasing cardiac output. - Correct answer ANS: A, C, D  The location of the obstruction in the urinary tract determines the method by which the  obstruction is treated and may include bladder catheterization, ureteral stenting, or the  placement of nephrostomy tubes. Fluid volume intake may be recommended to treat  prerenal causes of AKI. Increasing cardiac output would be indicated in certain prerenal  causes of AKI.  DIF: Cognitive Level: Remember/Knowledge REF: p. 422  OBJ: Review the anatomy and physiology of the renal system.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Noninvasive diagnostic procedures used to determine kidney function include which of the  following? (Select all that apply.) o Kidney, ureter, bladder (KUB) x-ray o Renal ultrasound o Magnetic resonance imaging (MRI) o Intravenous pyelography (IVP) o Renal angiography - Correct answer ANS: A, B, C  Noninvasive diagnostic procedures are usually performed before any invasive diagnostic  procedures are conducted. Noninvasive diagnostic procedures that assess the renal system  are radiography of the kidneys, ureters, and bladder (KUB); renal ultrasonography; and  magnetic resonance imaging. Invasive diagnostic procedures for assessing the renal system  include intravenous pyelography, computed tomography, renal angiography, renal scanning,  and renal biopsy.  DIF: Cognitive Level: Remember/Knowledge REF: p. 428  OBJ: Describe the methods for assessing the renal system, including physical assessment,  and interpretation of laboratory values and radiological diagnostic tests.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  The most common reasons for initiating dialysis in acute kidney injury include which of the  following? (Select all that apply.) o Acidosis o Hypokalemia o Volume overload o Hyperkalemia o Uremia - Correct answer ANS: A, C, D, E  The most common reasons for initiating dialysis in acute kidney injury include acidosis,  hyperkalemia, volume overload, and uremia. Dialysis is usually started early in the course of  the renal dysfunction before uremic complications occur. In addition, dialysis may be started  for fluid management when total parenteral nutrition is administered.  DIF: Cognitive Level: Remember/Knowledge REF: p. 434  OBJ: Describe the medical management of the patient with acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Complications common to patients receiving hemodialysis for acute kidney injury include  which of the following? (Select all that apply.) o Hypotension o Dysrhythmias o Muscle cramps o Hemolysis o Air embolism - Correct answer ANS: A, B  Hypotension is common and is usually the result of preexisting hypovolemia, excessive  amounts of fluid removal, or excessively rapid removal of fluid. Dysrhythmias may occur  during dialysis. Causes of dysrhythmias include a rapid shift in the serum potassium level,  clearance of antidysrhythmic medications, preexisting coronary artery disease, hypoxemia,  or hypercalcemia from rapid influx of calcium from the dialysate solution. Muscle cramps  occur more commonly in chronic renal failure. Hemolysis, air embolism, and hyperthermia  are rare complications of hemodialysis.  DIF: Cognitive Level: Remember/Knowledge REF: p. 435  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Assessment