Chapter 47: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease

Chapter 47: Nursing Management: Acute Kidney Injury and Chronic Kidney
Disease

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE
1. After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient
complains of pain and coldness of the right fingers. Which action should the nurse take?
a. Elevate the patient’s arm above the level of the heart.
b. Report the patient’s symptoms to the health care provider.
c. Remind the patient about the need to take a daily low-dose aspirin tablet.
d. Educate the patient about the normal vascular response after AVG insertion.
ANS: B
The patient’s complaints suggest the development of distal ischemia (steal syndrome) and
may require revision of the AVG. Elevation of the arm above the heart will decrease
perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not
used to maintain grafts.
DIF: Cognitive Level: Application REF: 1184-1185
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A patient with acute kidney injury (AKI) has an arterial blood pH of 7.30. The nurse will
assess the patient for
a. vasodilation.
b. poor skin turgor.
c. bounding pulses.
d. rapid respirations.
ANS: D
Patients with metabolic acidosis caused by AKI may have Kussmaul respirations as the
lungs try to regulate carbon dioxide. Bounding pulses and vasodilation are not associated
with metabolic acidosis. Because the patient is likely to have fluid retention, poor skin
turgor would not be a finding in AKI.
DIF: Cognitive Level: Application REF: 1167
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. A patient with severe heart failure develops elevated blood urea nitrogen (BUN) and
creatinine levels. The nurse will plan care to meet the goal of
a. replacing fluid volume.
b. preventing hypertension.
c. maintaining cardiac output.
d. diluting nephrotoxic substances.
Test Bank 47-2
ANS: C
The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and
provide supportive care while the kidneys recover. Because this patient’s heart failure is
causing AKI, the care will be directed toward treatment of the heart failure. For renal
failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would
be correct.
DIF: Cognitive Level: Application REF: 1165 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
4. A patient who has acute glomerulonephritis is hospitalized with acute kidney injury
(AKI) and hyperkalemia. Which information will the nurse obtain to evaluate the
effectiveness of the prescribed calcium gluconate IV?
a. Urine output
b. Calcium level
c. Cardiac rhythm
d. Neurologic status
ANS: C
The calcium gluconate helps prevent dysrhythmias that might be caused by the
hyperkalemia. The nurse will monitor the other data as well, but these will not be helpful
in determining the effectiveness of the calcium gluconate.
DIF: Cognitive Level: Application REF: 1168 TOP: Nursing Process:
Evaluation
MSC: NCLEX: Physiological Integrity
5. A patient with stage 2 chronic kidney disease (CKD) is scheduled for an intravenous
pyelogram (IVP). Which of these orders for the patient will the nurse question?
a. NPO for 6 hours before IVP procedure
b. Normal saline 500 mL IV before procedure
c. Ibuprofen (Advil) 400 mg PO PRN for pain
d. Dulcolax suppository 4 hours before IVP procedure
ANS: C
The contrast dye used in IVPs is potentially nephrotoxic, and concurrent use of other
nephrotoxic medications such as the NSAIDs should be avoided. The suppository and
NPO status are necessary to ensure adequate visualization during the IVP. IV fluids are
used to ensure adequate hydration, which helps reduce the risk for contrast-induced renal
failure.
DIF: Cognitive Level: Application REF: 1169-1170
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity