Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth
Essentials Of Pathophysiology Concepts of Altered States 4th Edition By Porth
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Chapter 26- Acute Kidney Injury and Chronic Kidney Disease
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | A diabetic client with a history of hypertension may receive a prescription for which medication to provide a renal protective effect by reducing intraglomerular pressure? Select all that apply. | |
| A) | Loop diuretics | |
| B) | ACE inhibitors | |
| C) | Angiotensin receptor blockers | |
| D) | Calcium channel blockers | |
| E) | A digitalis preparation | |
| Ans: | B, C | |
| Feedback: | ||
| The ACE inhibitors and ARBs reduce the effects of angiotensin II on renal blood flow. They also reduce intraglomerular pressure and may have a renal protective effect in persons with hypertension or type 2 diabetes. However, when combined with diuretics, they may cause prerenal injury in persons with decreased blood flow due to large-vessel or small-vessel kidney disease. Calcium channel blockers are vasodilators. | ||
| 2. | An 86-year-old female client has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to minimize urinary incontinence. The client’s admitting laboratory results are suggestive of prerenal failure. The nurse should be assessing this client for which of the following early signs of prerenal injury? | |
| A) | Sharp decrease in urine output | |
| B) | Excessive voiding of clear urine | |
| C) | Acute hypertensive crisis | |
| D) | Intermittent periods of confusion | |
| Ans: | A | |
| Feedback: | ||
| Dehydration and its consequent hypovolemia can result in acute renal failure that is prerenal in etiology. The kidney normally responds to a decrease in GFR with a decrease in urine output. Thus, an early sign of prerenal injury is a sharp decrease in urine output. Postrenal failure is obstructive in etiology, and intrinsic (or intrarenal) renal failure is reflective of deficits in the function of the kidneys themselves. | ||
| 3. | A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute: | |
| A) | Prerenal inflammation | |
| B) | Bladder outlet obstruction | |
| C) | Tubular necrosis | |
| D) | Intrarenal nephrotoxicity | |
| Ans: | C | |
| Feedback: | ||
| Ischemic acute tubular necrosis (ATN) occurs most frequently in persons who have major surgery with prolonged renal hypoperfusion—this directly damages the tubular epithelial cells with acute suppression of renal function. Nephrotoxic ATN is caused by toxic agents or drugs. Prerenal vasoconstriction is associated with acute-onset loss of renal output. Bladder (postrenal) obstruction would not affect the BUN, since it rarely causes renal failure. | ||
| 4. | A client with significant burns on his lower body has developed sepsis on the 3rd day following his accident. Which of the following manifestations would the nurse anticipate for an ischemic acute tubular necrosis rather than prerenal failure? The client: | |
| A) | Exhibits pulmonary and peripheral edema | |
| B) | GFR does not increase after restoration of renal blood flow | |
| C) | Undergoes emergent hemodialysis that does not result in decreased BUN and creatinine | |
| D) | Exhibits oliguria and frank hematuria | |
| Ans: | B | |
| Feedback: | ||
| In contrast to prerenal failure, the glomerular filtration rate (GFR) does not improve with the restoration of renal blood flow in acute renal failure caused by ischemic acute tubular necrosis. Edema, oliguria, and hematuria are not diagnostic of acute tubular necrosis (ATN), and hemodialysis does not normally fail to achieve a reduction in blood urea nitrogen (BUN) and creatinine. | ||
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