Acute Kidney Injury: Pathophysiology, Systemic Manifestations, and Assessment, Exams of Nursing

Download Acute Kidney Injury: Pathophysiology, Systemic Manifestations, and Assessment and more Exams Nursing in PDF only on Docsity! SOLE Chapter 16: Acute Kidney Injury TEST BANK examination 2024 with verified questions an answers  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.  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 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  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  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 has elevated blood urea nitrogen (BUN) and serum creatinine levels with a  normal BUN/creatinine ratio. These levels most likely indicate o increased nitrogen intake. o acute kidney injury, such as acute tubular necrosis (ATN). o hypovolemia. o fluid resuscitation. - Correct answer ANS: B  A normal BUN/creatinine ratio is present in ATN. In ATN, there is actual injury to the renal  tubules and a rapid decline in the GFR; hence, BUN and creatinine levels both rise  proportionally as a result of increased reabsorption and decreased clearance. Hypovolemia  would result in prerenal condition, which usually increases the BUN/creatinine ratio.  DIF: Cognitive Level: Understand/Comprehension REF: pp. 425-426  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 patient's serum creatinine level is 0.7 mg/dL. The expected BUN level should be o 1 to 2 mg/dL. o 7 to 14 mg/dL. o 10 to 20 mg/dL. o 20 to 30 mg/dL. - Correct answer ANS: B  The normal BUN/creatinine ratio is 10:1 to 20:1. Therefore, the expected range for this  creatinine level would be 7 to 14 mg/dL.  DIF: Cognitive Level: Analyze/Analysis REF: p. 425  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 determining the glomerular filtration rate (GFR) or creatinine clearance, a 24-hour urine  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.  increases plasma volume. Patients may be at risk for the development of pulmonary edema  due to the rapid expansion of intravascular volume triggered by mannitol. Hearing is  assessed with the administration of loop diuretics, such as furosemide, which have been  associated with deafness. Aggressive fluid administration is required in rhabdomyolysis.  Diuretics may increase the risk of acute kidney injury from volume depletion when they are  given before procedures requiring radiological contrast agents or if the patient is  hypovolemic. Adequate hydration before the administration of diuretics is essential.  DIF: Cognitive Level: Apply/Application REF: p. 431  OBJ: Describe the medical management of the patient with acute kidney injury.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  A 100-kg patient gets hemodialysis 3 days a week. In planning the care for this patient, the  nurse recommends o a diet of 2500 to 3500 kcal per day. o protein intake of less than 50 grams per day. o potassium intake of 10 mEq per day. 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  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  The nurse is caring for a patient who has a temporary percutaneous dialysis catheter in  place. In caring for this patient, the nurse should o apply a sterile gauze dressing to maintain sterility. o replace the transparent dressing every 10 days to prevent manipulation. o assess the catheter site for redness and/or swelling. o use the catheter for drawing blood samples to reduce patient discomfort. - Correct answer ANS: C  Tenderness at the insertion site, swelling, erythema, or drainage should be reported to the  physician. Transparent, semipermeable polyurethane dressings are recommended as they  allow continuous visualization for assessment of signs of infection. Replace transparent  dressings on temporary percutaneous catheters at least every 7 days and no more than once a  week for tunneled percutaneous catheters unless the dressing is soiled or loose. The catheter  is not used for the administration of fluids or medications or for the sampling of blood  unless a specific order is obtained to do so.  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 is getting hemodialysis for the second time when he complains of a headache  and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms  of o dialyzer membrane incompatibility. o a shift in potassium levels. o dialysis disequilibrium syndrome. o hypothermia. - Correct answer ANS: C  Dialysis disequilibrium syndrome often occurs after the first or second dialysis treatment or  in patients who have had sudden, large decreases in BUN and creatinine levels as a result of 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  The critical care nurse is responsible for monitoring the patient receiving CRRT. The  hemofilter is assessed every 2 to 4 hours for clotting (as evidenced by dark fibers or a rapid  decrease in the amount of ultrafiltration without a change in the patient's hemodynamic  status). The CRRT system is frequently assessed to ensure filter and lines are visible at all  times, kinks are avoided, and the blood tubing is warm to the touch. The ultrafiltrate is  assessed for blood (pink-tinged to frank blood), which is indicative of membrane rupture.  Sterile technique is performed during vascular access dressing changes.  DIF: Cognitive Level: Apply/Application REF: p. 438  OBJ: Discuss the nursing care of the patient receiving renal replacement therapy.  TOP: Nursing Process Step: Implementation  MSC: NCLEX Client Needs Category: Physiological Integrity  Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis o is more frequently used for acute kidney injury. o uses the patient's own semipermeable membrane (peritoneal membrane). o is not useful in cases of drug overdose or electrolyte imbalance. o is not indicated in cases of water intoxication. - Correct answer ANS: B  Peritoneal dialysis is the removal of solutes and fluid by diffusion through a patient's own  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,  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  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.)