Chapter 46: Acute Kidney Injury and Chronic Kidney Disease

Chapter 46: 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.	Teach the patient about normal AVG function.
b.	Remind the patient to take a daily low-dose aspirin tablet.
c.	Report the patient’s symptoms to the health care provider.
d.	Elevate the patient’s arm on pillows to above the heart level.

 

 

ANS:  C

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 further decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.

 

DIF:    Cognitive Level: Apply (application)           REF:               1088

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity

 

2. When a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30, the nurse will expect an assessment finding of

a.	persistent skin tenting	c.	hot, flushed face and neck.
b.	rapid, deep respirations.	d.	bounding peripheral pulses.

 

 

ANS:  B

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: Apply (application)           REF:               1072

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

3. The nurse is planning care for a patient with severe heart failure who has developed elevated blood urea nitrogen (BUN) and creatinine levels. The primary treatment goal in the plan will be

a.	augmenting fluid volume.	c.	diluting nephrotoxic substances.
b.	maintaining cardiac output.	d.	preventing systemic hypertension.

 

 

ANS:  B

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: Apply (application)           REF:               1073

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity

 

4. A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?

a.	Urine volume	c.	Cardiac rhythm
b.	Calcium level	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: Apply (application)           REF:               1073

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Physiological Integrity

 

5. Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse’s teaching about management of CKD has been effective?

a.	“I need to get most of my protein from low-fat dairy products.”
b.	“I will increase my intake of fruits and vegetables to 5 per day.”
c.	“I will measure my urinary output each day to help calculate the amount I can drink.”
d.	“I need to take erythropoietin to boost my immune system and help prevent infection.”

 

 

ANS:  C

The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

 

DIF:    Cognitive Level: Apply (application)           REF:               1082

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Physiological Integrity