Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease

Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the client’s recent history?
   1. Pyelonephritis
   2. Myocardial infarction
   3. Bladder cancer
   4. Kidney stones

ANS:   B

Pre-renal causes of AKI are related to a decrease in perfusion, such as with a myocardial infarction. Pyelonephritis is an intrinsic or intrarenal cause of AKI related to kidney damage. Bladder cancer and kidney stones are post-renal causes of AKI related to urine flow obstruction.

DIF:     Understanding/Comprehension         REF: 1412                   KEY: Renal system| pathophysiology| nursing analysis                  MSC:                         Integrated Process: Nursing Process: Analysis                                            NOT:                          Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A marathon runner comes into the clinic and states “I have not urinated very much in the last few days.” The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority?
   1. Give the client a bottle of water immediately.
   2. Start an intravenous line for fluids.
   3. Teach the client to drink 2 to 3 liters of water daily.
   4. Perform an electrocardiogram.

ANS:   A

This athlete is mildly dehydrated as evidenced by the higher heart rate and lower blood pressure. The nurse can start hydrating the client with a bottle of water first, followed by teaching the client to drink 2 to 3 liters of water each day. An intravenous line may be ordered later, after the client’s degree of dehydration is assessed. An electrocardiogram is not necessary at this time.

DIF:     Applying/Application                         REF: 1414                   KEY: Renal system| dehydration| nursing interventions                                      MSC:                         Integrated Process: Nursing Process: Implementation                                 NOT:                          Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this client’s history?
   1. “Have you been taking any aspirin, ibuprofen, or naproxen recently?”
   2. “Do you have anyone in your family with renal failure?”
   3. “Have you had a diet that is low in protein recently?”
   4. “Has a relative had a kidney transplant lately?”

ANS:           A

There are some medications that are nephrotoxic, such as the nonsteroidal anti-inflammatory drugs ibuprofen, aspirin, and naproxen. This would be a good question to initially ask the client since both the serum creatinine and BUN are elevated, indicating some renal problems. A family history of renal failure and kidney transplantation would not be part of the questioning and could cause anxiety in the client. A diet high in protein could be a factor in an increased BUN.

DIF:            Applying/Application                         REF: 1413                   KEY: Renal system| medications| nursing assessment                                                 MSC:                         Integrated Process: Nursing Process: Assessment                                               NOT:                          Client Needs Category: Physiological Integrity: Reduction of Risk Potential

4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this client’s care?
   1. Edema and pain
   2. Electrolyte and fluid imbalance
   3. Cardiac and respiratory status
   4. Mental health status

ANS:           B

This client may have an inflammatory cause of AKI with proteins entering the glomerulus and holding the fluid in the filtrate, causing polyuria. Electrolyte loss and fluid balance is essential. Edema and pain are not usually a problem with fluid loss. There could be changes in the client’s cardiac, respiratory, and mental health status if the electrolyte imbalance is not treated.

DIF:            Applying/Application                         REF: 1416                   KEY: Renal system| pathophysiology| dehydration                                MSC:                         Integrated Process: Nursing Process: Analysis                                                    NOT:                          Client Needs Category: Physiological Integrity: Physiological Adaptation