Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
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Chapter 42- Acute Renal Injury and Chronic Kidney Disease
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | Which of the following data would a clinician consider as most indicative of acute renal failure? | |
| A) | Alterations in blood pH; peripheral edema | |
| B) | Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) | |
| C) | Decreased serum creatinine and blood urea nitrogen (BUN); decreased potassium and calcium levels | |
| D) | Decreased urine output; hematuria; increased GFR | |
| Ans: | B | |
| Feedback: | ||
| The hallmark of acute renal injury is azotemia, an accumulation of nitrogenous wastes such as creatinine, urea nitrogen, and uric acid, plus a decrease in the GFR of the kidneys. While pH alterations, edema, electrolyte imbalances, and decreased urine output may accompany acute renal failure, they are all potentially attributable to other pathologies. Creatinine, GFR, and BUN would unlikely rise during renal failure. | ||
| 2. | Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply. | |
| A) | A 22-year-old male who has lost large amounts of blood following a workplace injury | |
| B) | A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis | |
| C) | A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and heart failure | |
| D) | A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug | |
| E) | A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH) | |
| F) | An 80-year-old female who has been admitted for the treatment of dehydration and malnutrition | |
| Ans: | A, C, F | |
| Feedback: | ||
| Hemorrhage, heart failure, and dehydration (hypovolemia) are all noted contributors to prerenal failure. Pyelonephritis and damage from nephrotoxic drugs would more likely result in intrinsic renal failure, while BPH is postrenal in nature. | ||
| 3. | The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session? | |
| A) | “The cardinal signs of ATN are oliguria and retention of potassium, creatinine, and sulfates.” | |
| B) | “Ureteral and bladder outlet obstructions are often contributors to ATN.” | |
| C) | “Trauma, burns, and major surgery are common precursors to ATN.” | |
| D) | “Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible.” | |
| Ans: | C | |
| Feedback: | ||
| ATN is often preceded by major surgery, burns, or trauma. Many cases of ATN are nonoliguric, and obstructions that are postrenal in nature are not common causes of ATN. Damage to tubular epithelial cells is not necessarily irreversible. | ||
| 4. | Which of the following patients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered at high risk for nephrotoxicity? Select all that apply. | |
| A) | A 14-year-old with severe abdominal pain | |
| B) | A 25-year-old with a history of glomerular nephritis who is complaining of severe flank pain | |
| C) | A 67-year-old diabetic undergoing diagnostic testing for new-onset proteinuria | |
| D) | A 45-year-old with elevated liver enzymes possibly due to fatty liver cirrhosis | |
| E) | A 53-year-old male undergoing biopsy for a suspicious “spot” on his chest x-ray | |
| Ans: | B, C | |
| Feedback: | ||
| Radiocontrast media-induced nephrotoxicity is thought to result from direct tubular toxicity and renal ischemia. The risk for renal damage caused by radiocontrast media is greatest in older adults and those with preexisting kidney disease, volume depletion, diabetes mellitus, and recent exposure to other nephrotoxic agents. | ||
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