Understanding Acute Kidney Injury: Pathophysiology, Management, and Diagnostic Tests, Exams of Nursing

Download Understanding Acute Kidney Injury: Pathophysiology, Management, and Diagnostic Tests and more Exams Nursing 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  A normal glomerular filtration rate is o less than 80 mL/min. o 80 to 125 mL/min. o 125 to 180 mL/min. o more than 189 mL/min. - Correct answer ANS: B  At a normal glomerular filtration rate (GFR) of 80 to 125 mL/min, the kidneys produce 180  L/day of filtrate. As the filtrate passes through the various components of the nephrons'  tubules, 99% is reabsorbed into the peritubular capillaries or vasa recta.  DIF: Cognitive Level: Remember/Knowledge REF: p. 448  OBJ: Review the anatomy and physiology of the renal system.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  A normal urine output is considered to be o 80 to 125 mL/min. o 180 L/day. o 80 mL/min. o 1 to 2 L/day. - Correct answer ANS: D  At a normal glomerular filtration rate (GFR) of 80 to 125 mL/min, the kidneys produce 180  L/day of filtrate. As the filtrate passes through the various components of the nephrons'  tubules, 99% is reabsorbed into the peritubular capillaries or vasa recta. Eventually, the  remaining filtrate (1% of the original 180 L/day) is excreted as urine, for an average urine  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 o contact the provider and expect a prescription for a normal saline bolus. o wait until the provider makes rounds to report the assessment findings. o continue to evaluate urine output for 2 more hours. o ignore the urine output, as this is most likely postrenal in origin. - Correct answer ANS: A  Most prerenal causes of AKI are related to intravascular volume depletion, decreased  cardiac output, renal vasoconstriction, or pharmacological agents that impair autoregulation  and GFR (Box 16-2). These conditions reduce the glomerular perfusion and the GFR, and  the kidneys are hypoperfused. For example, major abdominal surgery can cause  hypoperfusion of the kidney as a result of blood loss during surgery or as a result of excess  vomiting or nasogastric suction during the postoperative period. The body attempts to  normalize renal perfusion by reabsorbing sodium and water. If adequate blood flow is  restored to the kidney, normal renal function resumes. Most forms of prerenal AKI can be  reversed by treating the cause.  DIF: Cognitive Level: Apply/Application REF: Box 16-2  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  Acute kidney injury from postrenal etiology is caused by o obstruction of the flow of urine. o conditions that interfere with renal perfusion. o hypovolemia or decreased cardiac output. o conditions that act directly on functioning kidney tissue. - Correct answer ANS: A  Acute kidney injury resulting from obstruction of the flow of urine is classified as postrenal  or obstructive renal injury. Conditions that result in AKI by interfering with renal perfusion  are classified as prerenal and include hypovolemia and decreased cardiac output. Conditions  that produce AKI by directly acting on functioning kidney tissue are classified as intrarenal.  DIF: Cognitive Level: Remember/Knowledge REF: p. 422  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Conditions that produce acute kidney injury by directly acting on functioning kidney tissue  are classified as intrarenal. The most common intrarenal condition is o prolonged ischemia. o exposure to nephrotoxic substances. o acute tubular necrosis (ATN). o hypotension for several hours. - Correct answer ANS: C  The most common intrarenal condition is ATN. This condition may occur after prolonged  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  is obtained. If a reliable 24-hour urine collection is not possible, o it is not possible to determine the GFR. o the BUN may be used to determine renal function. o an elevated BUN/creatinine ratio can be used. o a standardized formula may be used to calculate GFR. - Correct answer ANS: D  Historically, timed 24-hour urine collections have been used to evaluate GFR or creatinine  clearance. If a reliable 24-hour urine collection is not possible, the Cockcroft and Gault  formula may be used to determine the creatinine clearance from a serum creatinine value.  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  Normal urine output is 0.5 to 1 mL/kg of body weight each hour.  DIF: Cognitive Level: Remember/Knowledge REF: p. 429  OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Daily weights are being recorded for the patient with a urine output that has been less than  the intravenous and oral intake. The weight yesterday was 97.5 kg. This morning it is 99 kg.  The nurse understands that this corresponds to a(n) o fluid retention of 1.5 liters. o fluid loss of 1.5 liters. o equal intake and output due to insensible losses. o fluid loss of 0.5 liters. - Correct answer ANS: A  A 1-kg gain in body weight is equal to a 1000-mL fluid gain. This patient has gained 1.5 kg,  or 1.5 liters of fluid.  DIF: Cognitive Level: Analyze/Analysis REF: p. 429  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 to the unit with the diagnosis of rhabdomyolysis. The patient is  started on intravenous (IV) fluids and IV mannitol. What action by the nurse is best? o Assess the patient's hearing. o Assess the patient's lungs. o Decrease IV fluids once the diuretic has been administered. 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. o diffusion. o clearance. o ultrafiltration. - Correct answer ANS: D  Ultrafiltration is the removal of plasma water and some low-molecular weight particles by  using a pressure or osmotic gradient. Ultrafiltration is primarily aimed at controlling fluid  volume, whereas dialysis is aimed at decreasing waste products and treating fluid and  electrolyte imbalances. Diffusion (or clearance) is the movement of solutes such as urea  from the patient's blood to the dialysate cleansing fluid, across a semipermeable membrane  (the hemofilter).  DIF: Cognitive Level: Remember/Knowledge 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 need of immediate hemodialysis, but has no vascular access. The nurse  prepares the patient for insertion of o a percutaneous catheter at the bedside. o a percutaneous tunneled catheter at the bedside. o an arteriovenous fistula. o an arteriovenous graft. - Correct answer ANS: A  Temporary percutaneous catheters are commonly used in patients with acute kidney injury  because they can be used immediately. Occasionally a percutaneous tunneled catheter is  placed if the patient needs ongoing hemodialysis; however, these catheters are usually  inserted in the operating room. 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. Arteriovenous grafts  are created by using different types of prosthetic material, most commonly  polytetrafluoroethylene and Teflon. Grafts are placed under the skin and are surgically  anastomosed between an artery and a vein. The graft site usually heals within 2 to 4 weeks.  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 a temporary percutaneous catheter in place for treatment of acute kidney  injury. The catheter has been in place for 5 days. The nurse should o prepare to assist with a routine dialysis catheter change. o evaluate the patient for signs and symptoms of infection. o teach the patient that the catheter is designed for long-term use. o use one of the three lumens for fluid administration. - Correct answer ANS: B  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.  those substances in the extracellular fluid. An osmotic concentration gradient established in  the brain allows fluid to enter until the concentration levels equal those of the extracellular  fluid. The extra fluid in the brain tissue creates a state of cerebral edema for the patient,  which results in severe headaches, nausea and vomiting, twitching, mental confusion, and  occasionally seizures. Dialyzer membrane incompatibility may cause hypotension.  Hyperthermia, not hypothermia, may result if the temperature control devices on the dialysis  machine malfunction. Potassium shifts may occur but would be manifested in cardiac  dysrhythmias.  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 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. o combine ultrafiltration, convection and dialysis - Correct answer ANS: C  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  hemofiltration (CVVH) is used to remove fluids and solutes through the process of  convection. Slow continuous ultrafiltration (SCUF) is also known as isolated ultrafiltration  and is used to remove plasma water in cases of volume overload. Continuous venovenous  hemodiafiltration (CVVHDF) combines ultrafiltration, convection, and dialysis to maximize  fluid and solute removal.  DIF: Cognitive Level: Remember/Knowledge REF: p. 438  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 critical care nurse is responsible for monitoring the patient receiving continuous renal  replacement therapy (CRRT). In doing so, the nurse should o assess that the blood tubing is warm to the touch. o assess the hemofilter every 6 hours for clotting. o cover the dialysis lines to protect them from light. o use clean technique during vascular access dressing changes. - Correct answer ANS: A  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  MSC: NCLEX Client Needs Category: Physiological Integrity  The patient has been admitted to the hospital with nausea and vomiting that started 5 days  earlier. Blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; the patient has not  voided in 8 hours, and the bladder is not distended. The nurse anticipates a prescription for  "stat" administration of o a blood transfusion. o fluid replacement with 0.45% saline. o infusion of an inotropic agent. o an antiemetic. - Correct answer ANS: B  This scenario indicates hypovolemia from the nausea and vomiting, requiring volume  replacement. Hypovolemia resulting from large urine or gastrointestinal losses often  requires the administration of a hypotonic solution, such as 0.45% saline. Blood products  would be indicated only in the presence of bleeding following assessment of hemoglobin  and hematocrit levels. The inotrope is contraindicated in the presence of volume depletion.  An antiemetic may be needed; however, the priority to prevent shock and acute kidney  injury is fluid administration.  DIF: Cognitive Level: Analyze/Analysis REF: p. 430  OBJ: Describe the medical management of the patient with acute kidney injury.  TOP: Nursing Process Step: Assessment  MSC: NCLEX Client Needs Category: Physiological Integrity  Identify which substances in the glomerular filtrate would indicate a problem with renal  function. (Select all that apply.) o Protein o Sodium o Creatinine o Red blood cells o Uric acid - Correct answer ANS: A, D  The glomerular capillary membrane is approximately 100 times more permeable than other  capillaries. It acts as a high-efficiency sieve and normally allows only substances with a  certain molecular weight to cross. 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.  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 patient is admitted with acute kidney injury from a postrenal cause. Acceptable  treatments for that diagnosis include: (Select all that apply.) o bladder catheterization. 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