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Lewis ch 47 Renal Disorders NCLEX

NCLEX renal disorder questions from Lewis Chapter 47 focusing on acute kidney injury (AKI) causes, including prerenal, intrarenal, postrenal factors, and acute tubular necrosis (ATN) scenarios.

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    Lewis ch 47 Renal Disorders NCLEX What are intrarenal causes of acute kidney injury (AKI) (select all diac apply)? a. Anaphylaxis b. Renal stones c. Bladder cancer d. Nephrotoxic drugs e. Acute glomemlor.ephritis f. Tubular obstruction by myoglobin - d, e, f. Intrarenal causes of acute kidney injury (AKI) include conditions that cause direct damage to rhe kidney tissue, including nephrotoxic drugs, acute glomerulonephritis, and tubular obstruction by myoglobin, or prolonged ischemia. Anaphylaxis and ocher prerenal problems are frequently rhe initial cause of AKI. Renal stones and bladder cancer are among the posrrenal causes of AKI. An 83-year-old female patient was found hung on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medicine or eat or drink anything since then. What conditions could be causing prerenal AKI in this patient (select all that apply)? a. Anaphylaxis b. Renal calculi c. Hypovolemia d. Nephrotoxic drugs e. Decreased cardiac output - c, e. Because the patient has had nothing to eat or drink for 2 days, she is probably dehydrated and hypovolemic. Decreased cardiac output (CO) is most likely because she is older and cakes heart medicine, which is probably for heart failure or hypertension. Both hypovolemia and decreased CO cause prerenal AKI. Anaphylaxis is also a cause of prerer.al AKI bur is not likely in this situation. Nephrotoxic drugs would contribute to intrarenal causes of AKI and renal calculi would be a postrenal cause of AKI. Acute tubular necrosis (ATN) is the most common cause of intrarenal AKI. Which patient is most likely to develop ATN? a. Patient with diabetes mellitus b. Patient with hypertensive crisis c. Patient who tried co overdose on acetaminophen d. Patient with major surgery who required a blood transfusion - d. Acute tubular necrosis (ATN) is primarily the result of ischemia, nephrotoxins, or sepsis. Major surgery is most likely to cause severe kidney ischemia in the patient requiring a blood transfusion. A blood transfusion hemoh tic reaction produces nephrotoxic injury if it occurs. Diabetes mellitus, hypertension, and acetaminophen overdose will not contribute to ATN. Priority Decision: A dehydrated patient is in the Injury stage of the RIFLE staging of AKI. What would ±e nurse

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    first anticipate in the treatment of this patient? a. Assess daily weight b. IV administration of fluid and furosemide (Lasix) c. IV administration of insulin and sodium bicarbonate d. Urinalysis to check for sediment, osmolality, sodium, and specific gravity - b. IV administration of fluid and furosemide (Lasix) Injur,' is the stage of RIFLE classification when urine output is less than 0.5 mL kg hr for 12 hours, the serum creatinine is increased times two or the glomerular filtration rate (GFR) is decreased by 50%. This stage may be reversible by treating the cause or, in this patient, the dehydration by administering IV fluid and a low dose of a loop diuretic, furosemide (Lasix). Assessing the daily weight will be done to monitor fluid changes but it is not the first treatment the nurse should anticipate. IV administration of insulin and sodium bicarbonate would be used for hyperkalemia. Checking the urinalysis will help to determine if the AKI has a prerenal, intrarenal, or postrenal cause by what is seen in the urine but with this patient's dehydration, it is thought to be prerenal to begin treatment. What indicates to the nurse that a patient with oliguria has prerenal oliguria? a. Urine testing reveals a low specific gravity. b. Causative factor is malignant hypertension. c. Urine testing reveals a high sodium concentration. d. Reversal of oliguria occurs with fluid replacement. - d. In prerenal oliguria, the oliguria is caused by a decrease in circulating blood volume and there is no damage yet to the renal tissue. It can be reversed by correcting the precipitating factor, such as fluid replacement for hypovolemia. Prerenal oliguria is characterized by urine with a high specific gravity and a low sodium concentration, whereas oliguria of intrarenal failure is characterized by urine with a low specific gravity and a high sodium concentration. Malignant hypertension causes damage to renal tissue and intrarenal oliguria. Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of a. ammonia synthesis. b. excretion of sodium. c. excretion of bicarbonate. d. conservation of potassium. - a. Metabolic acidosis occurs in AKI because the kidney’s cannot synthesize ammonia or excrete acid products of metabolism, resulting in ar. increased acid load. Sodium is lost in urine because the kidney's cannot conserve sodium. Impaired excretion of potassium results in hyperkalemia. Bicarbonate is normally generated and reabsorbed by the functioning kidney to maintain acidbase balance. What indicates to the nurse that a patient with AKI is in the recovery phase? a. A return to normal weight

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    b. A urine output of 3700 mL/day c. Decreasing sodium and potassium levels d. Decreasing blood urea nitrogen (BUN) and creatinine levels - d. The blood urea nitrogen (BUN) and creatinine levels remain high during the oliguric and diuretic phases of AKI . The recovery phase begins when the glomerular filtration returns to a rate at which BUN and creatinine stabilize and then decrease. Urinary output of 3 to 5 U day, decreasing sodium and potassium levels, and fluid weight loss are characteristic of the diuretic phase of AKI. While caring for the patient in the oliguric phase of AKI, the nurse monitors the patient for associated collaborative problems. When should the nurse notify die health care prorider? a. Urine output is 300 mL day. b. Edema occurs in the feet, legs, and sacral area. c. Cardiac monitor reveals a depressed T wave and elevated ST segment. d. The patient experiences increasing muscle weakness and abdominal cramping. - d. Hyperkalemia is a potentially life-threatening complication of AKI in the oliguric phase. Muscle weakness and abdominal cramping are signs of the neuromuscular impairment that occurs with hyperkalemia. Jr. addition, h}'perkalemia car. cause the cardiac conduction abnormalities of peaked T wave, prolonged PR interval, prolonged QRS interval, and depressed ST segment. Urine output of 300 mL day is expected during the oliguric phase, as is rhe development of peripheral edema. In caring for rhe patient with AKI, what should the nurse be aware of? a. The most common cause of death in xAKI is irreversible metabolic acidosis. b. During the oliguric phase of AKI, daily fluid intake is limited co 1000 mL plus the prior day's measured fluid loss. c. Dietar} 7 sodium and potassium during the oliguric phase of AKI are managed according to the patient's urinary output. d. One of the most important nursing measures in managing fluid balance in the patient with AKI is taking accurate daily weights. - d. Measuring, daily weights with the same scale at the same time each day allows for the evaluation and detection of excessive body fluid gains or losses. Infection is the leading cause of death in AKI, so meticulous aseptic technique is critical. The fluid limitation in the oliguric phase is 600 mL plus the prior day's measured fluid loss. Dietar} 7 sodium and potassium intake are managed according to the plasma levels. A 68-year-old man with a history of heart failure resulting from hypertension has AKI as a result of the effects of nephrotoxic diuretics. Currently his serum potassium is 6.2 iriEq.'L (6.2 mmol L) with cardiac changes, his BUN is 108 mg-’dL (38.6 mmoL'L), his serum creatinine is 4.1 mg dL (362 mmol L), and his serum HCO3- is 14 mEq.'L (14 mmol L). He is somnolent and disoriented. Which treatment should the nurse expect to be used for him? a. Loop diuretics b. Renal replacement therapy c. Insulin and sodium bicarbonate d. Sodium polystyrene sulfonate (Kayexalate) - b. This patient has at least three of the six common

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    indications for renal replacement therapy (RRT), including (1) high potassium level, (2) metabolic acidosis, and (3) changed mental stams. The other indications are (4) volume overload, resulting in compromised cardiac status (this patient has a history of hyq ertension), (5) BUN greater than 120 mg/dL, and (6) pericarditis, pericardial effusion, or cardiac tamponade. Although the other treatments may be used, they will not be as effective as RRT for this older patient. Loop diuretics and increased fluid are used if the patient is dehydrated. Insulin ar.d sodium bicarbonate car. be used to temporarily drive the potassium into the cells. Sodium polystyrene sulfonate (Kayexalate) is used to actually decrease rhe amount of potassium in the body. Prevention of AKI is important because of the high mortality rate. Which patients are at increased risk for AKI (select all that apply)? a. An 86-year-old woman scheduled for a cardiac catheterization b. A 48-year-old man with multiple injuries from a motor vehicle accident c. A 32-year-old woman following a C-section delivery 7 for abruptio placentae d. A 64-year-old woman with chronic heart failure admitted with bloody stools e. A 58-year-old man with prostate cancer undergoing preoperative workup for prostatectomy a, b, c, d, e. High-risk patients include those exposed to nephrotoxic agents and advanced age (a), massive trauma (b), prolonged hypovolemia or hypotension (possibly b and c), obstetric complications (c), cardiac failure (d), preexisting chronic kidney disease, extensive bums, or sepsis. Patients with prostate cancer may have obstruction of the outflow tract, which increases risk of postrenal AKI(e). Priority’ Decision: A patient on a medical unit has a potassium level of 6.8 mEq L. What is the priority' action that the nurse should take? a. Place the patient on a cardiac monitor. b. Check the patient's blood pressure (BP). c. Instruct the patient to ay’oid high-potassium foods. d. Call the lab and request a redraw’ of the lab to verify results. - a. Dy'srhylhmias may occur with an elevated potassium level and are potentially’ lethal. Monitor the rhythm while contacting the physician or calling the rapid response team. Vital signs should be checked. Depending on the patient's history 7 and cause of increased potassium, instruct rhe patient about dietary’ sources of potassium; how 7 ever, this yvould not help at this point. The nurse may want to recheck the value but until then the heart rhythm needs to be monitored. A patient with AKI has a serum potassium level of 6.7 mEq'L (6.7 mmol L) and the following arterial blood gas results: pH 7.28, PaCO2, 30 mm Hg, PaO2 86 mm Hg, HCO3- 18 rriEq-L (18 mmolL). Tne nurse recognizes that treatment of the acid-base problem with sodium bicarbonate would cause a decrease in which value? a. pH b. Potassium level c. Bicarbonate level d. Carbon dioxide ley’el - b. During acidosis, potassium moves out of the cell in exchange for H+

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    inns, increasing die serum potassium level. Correction of the acidosis with sodium bicarbonate will help to shift the potassium back into the cells. xA decrease in pH and the bicarbonate ar.d PaCO2 levels would indicate worsening acidosis. In replying to a patient s questions about the seriousness of her chronic kidney disease (CKD), the nurse knows that the stage of CKD is based on what? a. Total daily urine output b. Glomerular filtration rate c. Degree of altered mental status d. Serum creatinine ar.d urea levels - b. Stages of chronic kidney disease are based on the GFR. No specific markers of urinary output, mental status, or azotemia classify the degree of chronic kidney 7 disease (CKD). The patient with CKD is receiving dialysis, and rhe nurse observes excoriations on the patient's skin. What pathophysiologic changes in CKD can contribute to this finding (select all that apply)? a. Dry skin b. Sensom neuropathy 7 c. Vascular calcifications d. Calcium-phosphate skin deposits e. Uremic crystallization from high BUN - a, b, d. Pruritus is common in patients receiving dialysis. It causes scratching from dry’ skin, sensory’ neuropathy 7 , and calcium-phosphate deposition in the skin. Vascular calcifications contribute co cardiovascular disease, not to itching skin. Uremic frost rarely occurs without BUN levels greater than 200 mg dL, which should not occur in a patient on dialysis; urea crystallizes on the skin ar.d also causes pruritis. What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with CKD? a. High serum sodium levels b. Irritation of the GI tract from creatinine c. Increased ammonia from bacterial breakdown of urea d. Iron salts, calcium-containing phosphate binders, and limited fluid intake - c. Uremic fetor, or the urine odor of the breath, is caused by high urea content in the blood. Increased ammonia from bacterial breakdown of urea leads to stomatitis ar.d mucosal ulcerations. Irritation of the gastrointestinal (GI) tract from urea in CKD contributes to anorexia, nausea, and vomiting. Ingestion of iron salts and calcium-containing phosphate binders, limited fluid intake, and limited activity 7 cause constipation. The patient with CKD is brought to rhe emergency department with Kussmaul respirations. What does the nurse know about CKD that could cause this patient’s Kussmaul respirations?

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    a. Uremic pleuiiris is occurring. b. There is decreased pulmonary macrophage activity. c. They are caused by respiratory compensation for metabolic acidosis. d. Pulmonan. 7 edema from heart failure and fluid overload is occurring. - c. Kussmaul respirations occur with severe metabolic acidosis when the respiratory system is attempting to compensate by removing carbon dioxide with exhalations. Uremic pleuriris wrnuld cause a pleural friction nib. Decreased pulmonan,’ macrophage activity increases the risk of pulmonary infection. Dyspnea would occur with pulmonary edema. Which serum laboratory value indicates to the nurse that the patients CKD is getting worse? a. Decreased BUN b. Decreased sodium c. Decreased creatinine d. Decreased calculated glomerular filtration rate (GFR) - d. As GFR decreases., BUN and serum creatinine levels increase. Although elevated BUN and creatinine indicate that waste products are accumulating. the calculated GFR is considered a more accurate indicator of kidney Function than BUN or serum creatinine. What is the most serious electrolyte disorder associated with kidney disease? a. Hypocalcemia b. Hyperkalemia c. Hyponatremia d. Hypermagnesemia - b. Hyperkalemia can lead to life-threatening dysrhythmias. Hypocalcemia leads to an accelerated rate of bone remodeling and potentially to tetany. Hyponatremia may lead to confusion. Elevated sodium levels lead to edema, hjpertension, and heart failure. Hypermagnesemia may decrease reflexes, mental status, and blood pressure. For a patient with CKD the nurse identifies a nursing diagnosis of risk for injury: fracture related to alterations in calcium and phosphorus metabolism. What is the pathologic process directly related to the increased risk for fractures? a. Loss of aluminum through the impaired kidneys b. Deposition of calcium phosphate in soft tissues of the body c. Impaired vitamin D activation resulting in decreased GI absorption of calcium d. Increased release of parathyroid hormone in response to decreased calcium levels - c. The calcium-phosphorus imbalances that occur in CKD result in hypocalcemia, from a deficiency of active vitamin D and increased phosphorus levels. This leads to an increased rate of bone remodeling with a weakened bone matrix. Aluminum accumulation is also believed to contribute to the osteomalacia. Osteitis fibrosa involves

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    replacement of calcium in the bone with fibrous tissue and is primarily a result of elevated levels of parathyToid hormone resulting from hypocalcemia. Priority Decision: What is the most appropriate snack for the nurse to offer a patient with stage 4 CKD? a. Raisins b. Ice cream c. Dill pickles d. Hard candy - d. A patient with CKD may have unlimited intake of sugars and starches (unless the patient is diabetic) and hard candy is ar. appropriate snack and may help to relieve the metallic and urine taste that is common in the mouth. Raisins are a high- potassium food. Ice cream contains protein and phosphate and counts as fl’_rid_ Pickled foods have high sodium content. Lewis, Sharon L.; Dirksen, Shannon Ruff; Bucher. Linda (2014-03-14). Stud} 7 Guide for Medical-Surgical Nursing: Assessment and Management of Clinical Problems (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 413). Elsevier Health Sciences. Kindle Edition. Which complication of chronic kidney disease is treated with erythropoietin (EPO)? a. Anemia b. Hypertension c. Hyperkalemia d. Mineral and bone disorder - a. Erythropoietin is used to treat anemia, as it stimulates the bone marrow to produce red blood cells. The patient with CKD asks why she is receiving nifedipine (Procardia) and furosemide (Lasix). Tne nurse understands that these drugs are being used to treat the patient's a. anemia. b. hypertension. c. hyperkalemia. d. mineral and bone disorder. - b. Nifedipine (Procardia) is a calcium channel blocker and furosemide (Lasix) is a loop diuretic. Both are used to treat hypertension. Which drugs will be used to treat the patient with CKD for mineral and bone disorder (select all that apply)? a. Cinacalcet (Sensipar) b. Se -elamer (Renagel) c. IV glucose and insulin d. Calcium acetate (PhosLo) e. IV 10% calcium gluconate - a, b, d. Cinacalcet (Sensipar), a calcimimetic agent to control secondary 7 hy’perparathyToidism; sevelamer (Renagel), a noncalcium phosphate binder; and calcium

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    acetate (PhosLo), a calcium-based phosphate binder ate used to treat mineral ar.d bone disorder in CKD. IV glucose and insulin and IV 10% calcium gluconate along with sodium polystyrene sulfonate (Kayexalate) are used to treat the hyperkalemia of CKD. What accurately describes the care of the patient with CKD? a. A nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable is iron. b. The s 'ndrome that includes all of the signs ar.d symptoms seen in rhe various body systems in CKD is azotemia. c. The use of morphine is contraindicated in the patient with CKD because accumulation of its metabolites may cause seizures. d. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when serum calcium levels are increased. - d. In rhe patient with CKD, when serum calcium levels are increased, calcium-based phosphate binders are not used. The nutrient supplemented for patients on dialysis is folic acid. The various body system manifestations occur with uremia, which includes azotemia. Meperidine is contraindicated in patients with CKD related to possible seizures. During the nursing assessment of ±e patient with renal insufficiency, the nurse asks the patient specifically about a history of a. angina. b. asthma. c. hypertension. d. rheumatoid arthritis. - c. The most common causes of CKD in the United States are diabetes mellitus and hj pertension. The nurse should obtain information on long-term health problems that are related to kidney disease. The other disorders are not closely associated with renal disease. The patient with chronic kidney disease is considering whether to use peritoneal dialysis (PD) or hemodialysis (HD). What are advantages of PD when compared to HD (select all that apply)? a. Less protein loss b. Rapid fluid removal c. Less cardiovascular stress d. Decreased hyperlipidemia e. Requires fewer dietar,' restrictions - c, e. Peritoneal dialysis is less stressful for the cardiovascular system and requires fewer dietary restrictions. Peritoneal dialysis actually contributes to mote protein loss and increased h 'perlipidemia. The fluid ar.d creatinine removal are slower with peritoneal dialysis than hemodialysis. What does the dialysate for PD routinely contain?

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