Acute Kidney Injury: Pathophysiology, Causes, and Manifestations, Exams of Biology

Download Acute Kidney Injury: Pathophysiology, Causes, and Manifestations and more Exams Biology in PDF only on Docsity! SOLE Chapter 16: Acute Kidney Injury TEST BANK examination test 2024 1. The critical care nurse knows that in critically ill patients, renal dysfunction a. is a very rare problem. b. affects nearly two thirds of patients. c. has a low mortality rate once renal replacement therapy has been initiated. d. has little effect on morbidity, mortality, or quality of life. - Correct answer ANS: B 2. The kidney is the primary regulator of the body's internal environment. With sudden 3. cessation of renal function, all body systems are affected by the inability to maintain fluid 4. and electrolyte balance and eliminate metabolic waste. Renal dysfunction is a common 5. problem in critically ill patients, with nearly two thirds of patients experiencing some degree 6. of renal dysfunction. The most severe cases, requiring renal replacement therapy, have a 7. reported mortality rate of 50% to 60%. Acute kidney injury that progresses to chronic renal 8. failure is associated with increased morbidity, mortality, and reduced quality of life. 9. DIF: Cognitive Level: Remember/Knowledge REF: p. 417 10. OBJ: Review the anatomy and physiology of the renal system. 11. TOP: Nursing Process Step: Assessment 12. MSC: NCLEX Client Needs Category: Physiological Integrity 13. The nurse is caring for a patient who has sustained blunt trauma to the left flank area, and is 14. evaluating the patient's urinalysis results. The nurse should become concerned when a. creatinine levels in the urine are similar to blood levels of creatinine. b. sodium and chloride are found in the urine. c. urine uric acid levels have the same values as serum levels. d. red blood cells and albumin are found in the urine. - Correct answer ANS: D 15. Normal glomerular filtrate is basically protein free and contains electrolytes, including 16. sodium, chloride, and phosphate, and nitrogenous waste products, such as creatinine, urea, 17. and uric acid, in amounts similar to those in plasma. Red blood cells, albumin, and globulin 18. are too large to pass through the healthy glomerular membrane. Their presence in urine may 19. indicate glomerular damage. 20. DIF: Cognitive Level: Understand/Comprehension REF: p. 418 21. OBJ: Review the anatomy and physiology of the renal system. 22. TOP: Nursing Process Step: Assessment 23. MSC: NCLEX Client Needs Category: Physiological Integrity 24. A normal glomerular filtration rate is a. less than 80 mL/min. b. 80 to 125 mL/min. c. 125 to 180 mL/min. d. more than 189 mL/min. - Correct answer ANS: B 25. At a normal glomerular filtration rate (GFR) of 80 to 125 mL/min, the kidneys produce 180 26. L/day of filtrate. As the filtrate passes through the various components of the nephrons' 27. tubules, 99% is reabsorbed into the peritubular capillaries or vasa recta. 28. DIF: Cognitive Level: Remember/Knowledge REF: p. 448 29. OBJ: Review the anatomy and physiology of the renal system. 30. TOP: Nursing Process Step: Assessment 31. MSC: NCLEX Client Needs Category: Physiological Integrity 32. A normal urine output is considered to be a. 80 to 125 mL/min. b. 180 L/day. c. 80 mL/min. d. 1 to 2 L/day. - Correct answer ANS: D 33. At a normal glomerular filtration rate (GFR) of 80 to 125 mL/min, the kidneys produce 180 34. L/day of filtrate. As the filtrate passes through the various components of the nephrons' 35. tubules, 99% is reabsorbed into the peritubular capillaries or vasa recta. Eventually, the 36. remaining filtrate (1% of the original 180 L/day) is excreted as urine, for an average urine 37. output of 1 to 2 L/day. 38. DIF: Cognitive Level: Remember/Knowledge REF: p. 418 39. OBJ: Review the anatomy and physiology of the renal system. 87. The most common cause of acute kidney injury in critically ill patients is a. sepsis. b. fluid overload. c. medications. d. hemodynamic instability. - Correct answer ANS: A 88. The etiology of AKI in critically ill patients is often multifactorial and develops from a 89. combination of hypovolemia, sepsis, medications, and hemodynamic instability. Sepsis is 90. the most common cause of AKI. 91. DIF: Cognitive Level: Remember/Knowledge REF: p. 419 92. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 93. TOP: Nursing Process Step: Assessment 94. MSC: NCLEX Client Needs Category: Physiological Integrity 95. The nurse is caring for a patient who has undergone major abdominal surgery. The nurse 96. notices that the patient's urine output has been less than 20 mL/hour for the past 2 hours. 97. The patient's blood pressure is 100/60 mm Hg, and the pulse is 110 beats/min. Previously, 98. the pulse was 90 beats/min with a blood pressure of 120/80 mm Hg. The nurse should a. contact the provider and expect a prescription for a normal saline bolus. b. wait until the provider makes rounds to report the assessment findings. c. continue to evaluate urine output for 2 more hours. d. ignore the urine output, as this is most likely postrenal in origin. - Correct answer ANS: A 99. Most prerenal causes of AKI are related to intravascular volume depletion, decreased 100. cardiac output, renal vasoconstriction, or pharmacological agents that impair autoregulation 101. and GFR (Box 16-2). These conditions reduce the glomerular perfusion and the GFR, and 102. the kidneys are hypoperfused. For example, major abdominal surgery can cause 103. hypoperfusion of the kidney as a result of blood loss during surgery or as a result of excess 104. vomiting or nasogastric suction during the postoperative period. The body attempts to 105. normalize renal perfusion by reabsorbing sodium and water. If adequate blood flow is 106. restored to the kidney, normal renal function resumes. Most forms of prerenal AKI can be 107. reversed by treating the cause. 108. DIF: Cognitive Level: Apply/Application REF: Box 16-2 109. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 110. TOP: Nursing Process Step: Implementation 111. MSC: NCLEX Client Needs Category: Physiological Integrity 112. Acute kidney injury from postrenal etiology is caused by a. obstruction of the flow of urine. b. conditions that interfere with renal perfusion. c. hypovolemia or decreased cardiac output. d. conditions that act directly on functioning kidney tissue. - Correct answer ANS: A 113. Acute kidney injury resulting from obstruction of the flow of urine is classified as postrenal 114. or obstructive renal injury. Conditions that result in AKI by interfering with renal perfusion 115. are classified as prerenal and include hypovolemia and decreased cardiac output. Conditions 116. that produce AKI by directly acting on functioning kidney tissue are classified as intrarenal. 117. DIF: Cognitive Level: Remember/Knowledge REF: p. 422 118. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 119. TOP: Nursing Process Step: Assessment 120. MSC: NCLEX Client Needs Category: Physiological Integrity 121. Conditions that produce acute kidney injury by directly acting on functioning kidney tissue 122. are classified as intrarenal. The most common intrarenal condition is a. prolonged ischemia. b. exposure to nephrotoxic substances. c. acute tubular necrosis (ATN). d. hypotension for several hours. - Correct answer ANS: C 123. The most common intrarenal condition is ATN. This condition may occur after prolonged 124. ischemia (prerenal), exposure to nephrotoxic substances, or a combination of these. Some 125. patients have ATN after only several minutes of hypotension or hypovolemia, whereas 126. others can tolerate hours of renal ischemia without having any apparent tubular damage. 127. DIF: Cognitive Level: Remember/Knowledge REF: p. 420 128. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 129. TOP: Nursing Process Step: Assessment 130. MSC: NCLEX Client Needs Category: Physiological Integrity 131. The patient undergoes a cardiac catheterization that requires the use of contrast dyes during 132. the procedure. To detect signs of contrast-induced kidney injury, the nurse should a. not be concerned unless urine output decreases. b. evaluate the patient's serum creatinine for up to 72 hours after the procedure. c. obtain an order for a renal ultrasound. d. evaluate the patient's postvoid residual volume to detect intrarenal injury. - Correct answer ANS: B 133. Contrast- induced kidney injury is diagnosed by an increase in serum creatinine of 25%, or 134. 0.5 mg/dL, within 48 to 72 hours following the administration of contrast. Urine output 135. usually remains normal. The renal ultrasound and postvoid residual assessment are not 136. warranted. 137. DIF: Cognitive Level: Analyze/Analysis REF: p. 421 138. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 139. TOP: Nursing Process Step: Assessment 140. MSC: NCLEX Client Needs Category: Physiological Integrity 141. The nurse is caring for a patient with acute kidney injury who is being treated with 142. hemodialysis. The patient asks if he will need dialysis for the rest of his life. Which of the 143. following would be the best response? a. "Unfortunately, kidney injury is not reversible; it is permanent." b. "Kidney function usually returns within 2 weeks." c. "You will know for sure if you start urinating a lot all at once." d. "Recovery is possible, but it may take several months." - Correct answer ANS: D 144. Renal dysfunction is potentially reversible during the initiation phase. This phase spans 145. several hours to 2 days, during which time the normal renal processes begin to deteriorate, 146. but actual intrinsic renal damage has not yet occurred. During the maintenance phase, b. the BUN may be used to determine renal function. c. an elevated BUN/creatinine ratio can be used. d. a standardized formula may be used to calculate GFR. - Correct answer ANS: D 190. Historically, timed 24-hour urine collections have been used to evaluate GFR or creatinine 191. clearance. If a reliable 24-hour urine collection is not possible, the Cockcroft and Gault 192. formula may be used to determine the creatinine clearance from a serum creatinine value. 193. The BUN level is not a reliable indicator of kidney function because the rate of protein 194. metabolism is not constant. An increased BUN/creatinine ratio is typically noted with 195. prerenal conditions, but does not provide an estimate of GFR. 196. DIF: Cognitive Level: Understand/Comprehension REF: p. 427 197. OBJ: Describe the methods for assessing the renal system, including physical assessment, 198. and interpretation of laboratory values and radiological diagnostic tests. 199. TOP: Nursing Process Step: Assessment 200. MSC: NCLEX Client Needs Category: Physiological Integrity 201. In calculating the glomerular filtration rate (GFR) results for women, the creatinine 202. clearance is usually: a. the same as for men. b. greater than that for men. c. multiplied by 0.85. d. multiplied by 1.15. - Correct answer ANS: C 203. For women, the calculated result is multiplied by 0.85 to account for the smaller muscle 204. mass as compared to men. 205. DIF: Cognitive Level: Remember/Knowledge REF: p. 427 206. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 207. TOP: Nursing Process Step: Assessment 208. MSC: NCLEX Client Needs Category: Physiological Integrity 209. The patient is admitted with complaints of general malaise and fatigue, along with a 210. decreased urinary output. The patient's urinalysis shows coarse, muddy brown granular 211. casts and hematuria. The nurse determines that the patient has: a. acute kidney injury from a prerenal condition. b. acute kidney injury from postrenal obstruction. c. intrarenal disease, probably acute tubular necrosis. d. a urinary tract infection. - Correct answer ANS: C 212. Analysis of urinary sediment and electrolyte levels is helpful in distinguishing among the 213. various causes of acute kidney injury. Coarse, muddy brown granular casts are classic 214. findings in ATN. Microscopic hematuria and a small amount of protein also may be seen. In 215. prerenal conditions, the urine typically has no cells but may contain hyaline casts. Postrenal 216. conditions may present with stones, crystals, sediment, bacteria, and clots from the 217. obstruction. Bacteria would be present in a urinary tract infection. 218. DIF: Cognitive Level: Analyze/Analysis REF: p. 427 219. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 220. TOP: Nursing Process Step: Assessment 221. MSC: NCLEX Client Needs Category: Physiological Integrity 222. The patient is complaining of severe flank pain when he tries to urinate. His urinalysis 223. shows sediment and crystals along with a few bacteria. Using this information along with 224. the clinical picture, the nurse realizes that the patient's condition is a. prerenal. b. postrenal. c. intrarenal. d. not renal related. - Correct answer ANS: B 225. Analysis of urinary sediment and electrolyte levels is helpful in distinguishing among the 226. various causes of acute kidney injury. Postrenal conditions may present with stones, 227. crystals, sediment, bacteria, and clots from the obstruction. Coarse, muddy brown granular 228. casts are classic findings in ATN (intrarenal), along with microscopic hematuria and a small 229. amount of protein. In prerenal conditions, the urine typically has no cells but may contain 230. hyaline casts. The flank pain and urinalysis definitely indicate a renal condition. 231. DIF: Cognitive Level: Remember/Knowledge REF: p. 427 232. OBJ: Describe the methods for assessing the renal system, including physical assessment, 233. and interpretation of laboratory values and radiological diagnostic tests. 234. TOP: Nursing Process Step: Assessment 235. MSC: NCLEX Client Needs Category: Physiological Integrity 236. What is a minimally acceptable urine output for a patient weighing 75 kg? a. Less than 30 mL/hour b. 37 mL/hour c. 80 mL/hour d. 150 mL/hour - Correct answer ANS: B 237. Normal urine output is 0.5 to 1 mL/kg of body weight each hour. 238. DIF: Cognitive Level: Remember/Knowledge REF: p. 429 239. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 240. TOP: Nursing Process Step: Assessment 241. MSC: NCLEX Client Needs Category: Physiological Integrity 242. Daily weights are being recorded for the patient with a urine output that has been less than 243. the intravenous and oral intake. The weight yesterday was 97.5 kg. This morning it is 99 kg. 244. The nurse understands that this corresponds to a(n) a. fluid retention of 1.5 liters. b. fluid loss of 1.5 liters. c. equal intake and output due to insensible losses. d. fluid loss of 0.5 liters. - Correct answer ANS: A 245. A 1-kg gain in body weight is equal to a 1000-mL fluid gain. This patient has gained 1.5 kg, 246. or 1.5 liters of fluid. 247. DIF: Cognitive Level: Analyze/Analysis REF: p. 429 248. OBJ: Describe the pathophysiology and systemic manifestations of acute kidney injury. 249. TOP: Nursing Process Step: Assessment 250. MSC: NCLEX Client Needs Category: Physiological Integrity 251. The patient is admitted to the unit with the diagnosis of rhabdomyolysis. The patient is 252. started on intravenous (IV) fluids and IV mannitol. What action by the nurse is best? a. Assess the patient's hearing. b. Assess the patient's lungs. c. Decrease IV fluids once the diuretic has been administered. d. Give extra doses before giving radiological contrast agents. - Correct answer ANS: B 298. Treatment of metabolic acidosis depends on its severity. Patients with a serum bicarbonate 299. level of less than 15 mEq/L and a pH of less than 7.20 are usually treated with intravenous 300. sodium bicarbonate. The goal of treatment is to raise the pH to a value greater than 7.20. 301. Rapid correction of the acidosis should be avoided, because tetany may occur as a result of 302. hypocalcemia. Renal replacement therapies also may correct metabolic acidosis because it 303. removes excess hydrogen ions and bicarbonate is added to the dialysate and replacement 304. solutions; therefore, dialysis would not be canceled. The tachypnea is a compensatory 305. mechanism for the metabolic acidosis, and treatments to decrease the respiratory rate are not 306. indicated. Treatment is aimed at correcting the metabolic acidosis, and this scenario does 307. not provide data to support the need for intubation. 308. DIF: Cognitive Level: Analyze/Analysis REF: p. 432 309. OBJ: Describe the medical management of the patient with acute kidney injury. 310. TOP: Nursing Process Step: Implementation 311. MSC: NCLEX Client Needs Category: Physiological Integrity 312. The removal of plasma water and some low-molecular weight particles by using a pressure 313. or osmotic gradient is known as a. dialysis. b. diffusion. c. clearance. d. ultrafiltration. - Correct answer ANS: D 314. Ultrafiltration is the removal of plasma water and some low- molecular weight particles by 315. using a pressure or osmotic gradient. Ultrafiltration is primarily aimed at controlling fluid 316. volume, whereas dialysis is aimed at decreasing waste products and treating fluid and 317. electrolyte imbalances. Diffusion (or clearance) is the movement of solutes such as urea 318. from the patient's blood to the dialysate cleansing fluid, across a semipermeable membrane 319. (the hemofilter). 320. DIF: Cognitive Level: Remember/Knowledge REF: p. 434 321. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 322. TOP: Nursing Process Step: Assessment 323. MSC: NCLEX Client Needs Category: Physiological Integrity 324. The patient is in need of immediate hemodialysis, but has no vascular access. The nurse 325. prepares the patient for insertion of a. a percutaneous catheter at the bedside. b. a percutaneous tunneled catheter at the bedside. c. an arteriovenous fistula. d. an arteriovenous graft. - Correct answer ANS: A 326. Temporary percutaneous catheters are commonly used in patients with acute kidney injury 327. because they can be used immediately. Occasionally a percutaneous tunneled catheter is 328. placed if the patient needs ongoing hemodialysis; however, these catheters are usually 329. inserted in the operating room. An arteriovenous fistula is an internal, surgically created 330. communication between an artery and a vein. This method produces a vessel that is easy to 331. cannulate but requires 4 to 6 weeks before it is mature enough to use. Arteriovenous grafts 332. are created by using different types of prosthetic material, most commonly 333. polytetrafluoroethylene and Teflon. Grafts are placed under the skin and are surgically 334. anastomosed between an artery and a vein. The graft site usually heals within 2 to 4 weeks. 335. DIF: Cognitive Level: Apply/Application REF: p. 434 336. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 337. TOP: Nursing Process Step: Implementation 338. MSC: NCLEX Client Needs Category: Physiological Integrity 339. The patient has a temporary percutaneous catheter in place for treatment of acute kidney 340. injury. The catheter has been in place for 5 days. The nurse should a. prepare to assist with a routine dialysis catheter change. b. evaluate the patient for signs and symptoms of infection. c. teach the patient that the catheter is designed for long-term use. d. use one of the three lumens for fluid administration. - Correct answer ANS: B 341. Routine replacement of hemodialysis catheters to prevent infection is not recommended. 342. The decision to remove or replace the catheter is based on clinical need and/or signs and 343. symptoms of infection. The typical catheter has a single or double lumen and is designed 344. only for short-term renal replacement therapy during acute situations. The catheter is not 345. used for fluid and medication administration. 346. DIF: Cognitive Level: Apply/Application REF: p. 434 347. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 348. TOP: Nursing Process Step: Implementation 349. MSC: NCLEX Client Needs Category: Physiological Integrity 350. The patient has just returned from having an arteriovenous fistula placed. The patient asks, 351. "When will they be able to use this and take this other catheter out?" The nurse should 352. reply, a. "It can be used immediately, so the catheter can come out anytime." b. "It will take 2 to 4 weeks to heal before it can be used." c. "The fistula will be usable in about 4 to 6 weeks." d. "The fistula was made using graft material, so it depends on the manufacturer." - Correct answer ANS: C 353. An arteriovenous fistula is an internal, surgically created communication between an artery 354. and a vein. This method produces a vessel that is easy to cannulate but requires 4 to 6 weeks 355. before it is mature enough to use. 356. DIF: Cognitive Level: Understand/Comprehension REF: p. 434 357. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 358. TOP: Nursing Process Step: Assessment 359. MSC: NCLEX Client Needs Category: Physiological Integrity 360. The patient is in a progressive care unit following arteriovenous fistula implantation in his 361. left upper arm, and is due to have blood drawn with his next set of vital signs and 362. assessment. When the nurse assesses the patient, the nurse should a. draw blood from the left arm. b. take blood pressures from the left arm. c. start a new intravenous line in the left lower arm. d. auscultate the left arm for a bruit and palpate for a thrill. - Correct answer ANS: D 405. fluid. The extra fluid in the brain tissue creates a state of cerebral edema for the patient, 406. which results in severe headaches, nausea and vomiting, twitching, mental confusion, and 407. occasionally seizures. Dialyzer membrane incompatibility may cause hypotension. 408. Hyperthermia, not hypothermia, may result if the temperature control devices on the dialysis 409. machine malfunction. Potassium shifts may occur but would be manifested in cardiac 410. dysrhythmias. 411. DIF: Cognitive Level: Remember/Knowledge REF: p. 436 412. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 413. TOP: Nursing Process Step: Assessment 414. MSC: NCLEX Client Needs Category: Physiological Integrity 415. Continuous renal replacement therapy (CRRT) differs from conventional intermittent 416. hemodialysis in that a. a hemofilter is used to facilitate ultrafiltration. b. it provides faster removal of solute and water. c. it does not allow diffusion to occur. d. the process removes solutes and water slowly. - Correct answer ANS: D 417. CRRT is a continuous extracorporeal blood purification system managed by the bedside 418. critical care nurse. It is similar to conventional intermittent hemodialysis in that a hemofilter 419. is used to facilitate the processes of ultrafiltration and diffusion. It differs in that CRRT 420. provides a slow removal of solutes and water as compared to the rapid removal of water and 421. solutes that occurs with intermittent hemodialysis. 422. DIF: Cognitive Level: Remember/Knowledge REF: p. 436 423. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 424. TOP: Nursing Process Step: Assessment 425. MSC: NCLEX Client Needs Category: Physiological Integrity 426. Slow continuous ultrafiltration is also known as isolated ultrafiltration and is used to a. remove plasma water in cases of volume overload. b. remove fluids and solutes through the process of convection. c. remove plasma water and solutes by adding dialysate. d. combine ultrafiltration, convection, and dialysis. - Correct answer ANS: A 427. Slow continuous ultrafiltration (SCUF) is also known as isolated ultrafiltration and is used 428. to remove plasma water in cases of volume overload. Continuous venovenous 429. hemofiltration (CVVH) is used to remove fluids and solutes through the process of 430. convection. Continuous venovenous hemodialysis (CVVHD) is similar to CVVH in that 431. ultrafiltration removes plasma water. It differs in that dialysate solution is added around the 432. hemofilter membranes to facilitate solute removal by the process of diffusion. Continuous 433. venovenous hemodiafiltration (CVVHDF) combines ultrafiltration, convection, and dialysis 434. to maximize fluid and solute removal. 435. DIF: Cognitive Level: Remember/Knowledge REF: p. 436 436. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 437. TOP: Nursing Process Step: Assessment 438. MSC: NCLEX Client Needs Category: Physiological Integrity 439. Continuous venovenous hemofiltration is used to a. remove fluids and solutes through the process of convection. b. remove plasma water in cases of volume overload. c. remove plasma water and solutes by adding dialysate. d. combine ultrafiltration, convection, and dialysis. - Correct answer ANS: A 440. Continuous venovenous hemofiltration (CVVH) is used to remove fluids and solutes 441. through the process of convection. Slow continuous ultrafiltration (SCUF) is used to remove 442. plasma water in cases of volume overload. Continuous venovenous hemodialysis (CVVHD) 443. is similar to CVVH in that ultrafiltration removes plasma water. It differs in that dialysate 444. solution is added around the hemofilter membranes to facilitate solute removal by the 445. process of diffusion. Continuous venovenous hemodiafiltration (CVVHDF) combines 446. ultrafiltration, convection, and dialysis to maximize fluid and solute removal. 447. DIF: Cognitive Level: Remember/Knowledge REF: pp. 436-437 448. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 449. TOP: Nursing Process Step: Assessment 450. MSC: NCLEX Client Needs Category: Physiological Integrity 451. Continuous venovenous hemodialysis is used to a. remove fluids and solutes through the process of convection. b. remove plasma water in cases of volume overload. c. remove plasma water and solutes by adding dialysate. d. combine ultrafiltration, convection and dialysis - Correct answer ANS: C 452. Continuous venovenous hemodialysis (CVVHD) is similar to CVVH in that ultrafiltration 453. removes plasma water. It differs in that dialysate solution is added around the hemofilter 454. membranes to facilitate solute removal by the process of diffusion. Continuous venovenous 455. hemofiltration (CVVH) is used to remove fluids and solutes through the process of 456. convection. Slow continuous ultrafiltration (SCUF) is also known as isolated ultrafiltration 457. and is used to remove plasma water in cases of volume overload. Continuous venovenous 458. hemodiafiltration (CVVHDF) combines ultrafiltration, convection, and dialysis to maximize 459. fluid and solute removal. 460. DIF: Cognitive Level: Remember/Knowledge REF: p. 438 461. OBJ: Discuss the nursing care of the patient receiving renal replacement therapy. 462. TOP: Nursing Process Step: Assessment 463. MSC: NCLEX Client Needs Category: Physiological Integrity 464. The critical care nurse is responsible for monitoring the patient receiving continuous renal 465. replacement therapy (CRRT). In doing so, the nurse should a. assess that the blood tubing is warm to the touch. b. assess the hemofilter every 6 hours for clotting. c. cover the dialysis lines to protect them from light. d. use clean technique during vascular access dressing changes. - Correct answer ANS: A 466. The critical care nurse is responsible for monitoring the patient receiving CRRT. The 467. hemofilter is assessed every 2 to 4 hours for clotting (as evidenced by dark fibers or a rapid 468. decrease in the amount of ultrafiltration without a change in the patient's hemodynamic 512. output is considerably less than intake over the last shift, and daily weight is 1 kg more than 513. yesterday. The nurse should a. draw a trough level after the next dose of antibiotic. b. obtain an order to place the patient on fluid restriction. c. assess the patient's lungs. d. insert an indwelling catheter. - Correct answer ANS: C 514. The scenario indicates retention of fluid; therefore, the nurse must assess for symptoms of 515. fluid overload, for example, by auscultating the lung fields. Adequate hydration is essential 516. and fluid restriction would be determined by the provider upon physical examination and 517. analysis of laboratory results. An indwelling urinary catheter should not routinely be 518. inserted because it increases the risk of infection. A trough level is drawn just before the 519. next dose of a drug is given and is an indicator of how the body has cleared the drug; it 520. would not be done secondary to imbalanced intake and output. 521. DIF: Cognitive Level: Apply/Application REF: p. 439 522. OBJ: Describe the medical management of the patient with acute kidney injury. 523. TOP: Nursing Process Step: Implementation 524. MSC: NCLEX Client Needs Category: Physiological Integrity 525. The patient has been admitted to the hospital with nausea and vomiting that started 5 days 526. earlier. Blood pressure is 80/44 mm Hg and heart rate is 122 beats/min; the patient has not 527. voided in 8 hours, and the bladder is not distended. The nurse anticipates a prescription for 528. "stat" administration of a. a blood transfusion. b. fluid replacement with 0.45% saline. c. infusion of an inotropic agent. d. an antiemetic. - Correct answer ANS: B 529. This scenario indicates hypovolemia from the nausea and vomiting, requiring volume 530. replacement. Hypovolemia resulting from large urine or gastrointestinal losses often 531. requires the administration of a hypotonic solution, such as 0.45% saline. Blood products 532. would be indicated only in the presence of bleeding following assessment of hemoglobin 533. and hematocrit levels. The inotrope is contraindicated in the presence of volume depletion. 534. An antiemetic may be needed; however, the priority to prevent shock and acute kidney 535. injury is fluid administration. 536. DIF: Cognitive Level: Analyze/Analysis REF: p. 430 537. OBJ: Describe the medical management of the patient with acute kidney injury. 538. TOP: Nursing Process Step: Assessment 539. MSC: NCLEX Client Needs Category: Physiological Integrity 540. Identify which substances in the glomerular filtrate would indicate a problem with renal 541. function. (Select all that apply.) a. Protein b. Sodium c. Creatinine d. Red blood cells e. Uric acid - Correct answer ANS: A, D 542. The glomerular capillary membrane is approximately 100 times more permeable than other 543. capillaries. It acts as a high-efficiency sieve and normally allows only substances with a 544. certain molecular weight to cross. Normal glomerular filtrate is basically protein free and 545. contains electrolytes, including sodium, chloride, and phosphate, and nitrogenous waste 546. products, such as creatinine, urea, and uric acid, in amounts similar to those in plasma. Red 547. blood cells, albumin, and globulin are too large to pass through the healthy glomerular 548. membrane. 549. DIF: Cognitive Level: Remember/Knowledge REF: p. 418 550. OBJ: Review the anatomy and physiology of the renal system. 551. TOP: Nursing Process Step: Assessment 552. MSC: NCLEX Client Needs Category: Physiological Integrity 553. The patient is admitted with acute kidney injury from a postrenal cause. Acceptable 554. treatments for that diagnosis include: (Select all that apply.) a. bladder catheterization. b. increasing fluid volume intake. c. ureteral stenting. d. placement of nephrostomy tubes. e. increasing cardiac output. - Correct answer ANS: A, C, D 555. The location of the obstruction in the urinary tract determines the method by which the 556. obstruction is treated and may include bladder catheterization, ureteral stenting, or the 557. placement of nephrostomy tubes. Fluid volume intake may be recommended to treat 558. prerenal causes of AKI. Increasing cardiac output would be indicated in certain prerenal 559. causes of AKI. 560. DIF: Cognitive Level: Remember/Knowledge REF: p. 422 561. OBJ: Review the anatomy and physiology of the renal system. 562. TOP: Nursing Process Step: Assessment 563. MSC: NCLEX Client Needs Category: Physiological Integrity 564. Noninvasive diagnostic procedures used to determine kidney function include which of the 565. following? (Select all that apply.) a. Kidney, ureter, bladder (KUB) x-ray b. Renal ultrasound c. Magnetic resonance imaging (MRI) d. Intravenous pyelography (IVP) e. Renal angiography - Correct answer ANS: A, B, C 566. Noninvasive diagnostic procedures are usually performed before any invasive diagnostic 567. procedures are conducted. Noninvasive diagnostic procedures that assess the renal system 568. are radiography of the kidneys, ureters, and bladder (KUB); renal ultrasonography; and 569. magnetic resonance imaging. Invasive diagnostic procedures for assessing the renal system 570. include intravenous pyelography, computed tomography, renal angiography, renal scanning, 571. and renal biopsy. 572. DIF: Cognitive Level: Remember/Knowledge REF: p. 428 573. OBJ: Describe the methods for assessing the renal system, including physical assessment, 574. and interpretation of laboratory values and radiological diagnostic tests. 575. TOP: Nursing Process Step: Assessment 576. MSC: NCLEX Client Needs Category: Physiological Integrity 577. The most common reasons for initiating dialysis in acute kidney injury include which of the 578. following? (Select all that apply.) a. Acidosis b. Hypokalemia