Chapter 26 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 26 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

A patient who has acute kidney injury and who weighs 90 kg had a urine output of 25 mL over the last 12 hours. The nurse would place this patient in which RIFLE category?

1. Injury
2. Risk
3. Failure
4. Loss

Correct Answer: 3

Rationale 1: The injury level of RIFLE criteria is urine output less than 0.5mL/kg for 12 hours. This patient’s output is lower than that level.

Rationale 2: The risk level of RIFLE criteria is urine output less than 0.5 mL/kg for 6 hours. This patient’s output is lower than that level.

Rationale 3: According to the RIFLE criteria, failure is a urine output of less than 0.3 ml per kg of body weight or anuria for 12 hours. The patient’s urine output over the last 12 hours has been 25 mL, which would be comparable to the failure category within the RIFLE criteria.

Rationale 4: Loss is considered a complete loss of renal function for at least 4 weeks.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 26-2

 

Question 2

Type: MCSA

An elderly patient is scheduled for a CT scan with contrast. The nurse would anticipate preprocedure administration of which medication to help prevent renal damage?

1. N-acetylcysteine
2. Vitamin B12
3. Intravenous infusion of 5% dextrose
4. Vitamin D

Correct Answer: 1

Rationale 1: Since the use of contrast dyes can be nephrotoxic, steps must be taken to minimize nephrotoxicity. N-acetylcysteine may be given orally or intravenously before contrast administration. N-acetylcysteine acts as a free radical scavenger, counteracts vasoconstriction from contrast agents, and indirectly exhibits cytoprotective effects.

Rationale 2: Vitamin B12 does not offer kidney protection from contrast dyes.

Rationale 3: Since the use of contrast dyes can be nephrotoxic, steps must be taken to minimize nephrotoxicity. The patient should be adequately hydrated with sodium chloride.

Rationale 4: Vitamin D does not provide kidney protection from contrast dyes.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 26-1

 

Question 3

Type: MCMA

A patient’s acute kidney injury is suspected of being of postrenal etiology. Which medical history would support this diagnosis?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient has been taking NSAIDs for arthritis pain.
2. The patient was diagnosed with heart failure last week.
3. The patient reports having the “flu” with vomiting and diarrhea for the last 6 days.
4. The patient has large renal calculi in the kidney and ureter.
5. The patient was just diagnosed with prostate cancer.

Correct Answer: 4,5

Rationale 1: The intake of NSAIDs for arthritis would contribute to an intrinsic cause for an acute kidney injury.

Rationale 2: The diagnosis of heart failure would be considered a prerenal cause for an acute kidney injury.

Rationale 3: Vomiting and diarrhea for the last 6 days is considered a prerenal cause for an acute kidney injury.

Rationale 4: Large renal calculi in the kidney and ureter are considered a mechanical cause for a postrenal acute kidney injury since they affect urine drainage from the kidney.

Rationale 5: Prostate cancer can cause obstruction of the urethra, which can result in postrenal acute renal failure.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 26-1