Med Surg 2 Test 4: Elimination: PKD Polycystic Kidney Disease & Acute Kidney Injury

New Book

Brunner & Suddarth 14th ed

The nurse is assessing a patients bladder by percussion. The nurse
elicits dullness after the patient hasvoided. How should the
nurse interpret this assessment finding?A) The patients bladder
is not completely empty.B) The patient has kidney
enlargement.C) The patient has a ureteral obstruction.D)
The patient has a fluid volume deficit.

Ans: AFeedback:Dullness to percussion of the bladder
following voiding indicates incomplete bladder
emptying.Enlargement of the kidneys can be attributed to
numerous conditions such as polycystic kidney diseaseor
hydronephrosis and is not related to bladder fullness. Dehydration and
ureteral obstruction are notrelated to bladder fullness; in
fact, these conditions result in decreased flow of urine to the bladder.

The nurse coming on shift on the medical unit is taking a report on
four patients. What patient does thenurse know is at the
greatest risk of developing ESKD?A) A patient with a history of
polycystic kidney diseaseB) A patient with diabetes mellitus and
poorly controlled hypertensionC) A patient who is morbidly obese
with a history of vascular disordersTest Bank - Brunner &
Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
1019D) A patient with severe chronic obstructive pulmonary disease

Ans: BFeedback:Systemic diseases, such as diabetes
mellitus (leading cause); hypertension; chronic
glomerulonephritis;pyelonephritis; obstruction of the urinary
tract; hereditary lesions, such as in polycystic kidney
disease;vascular disorders; infections; medications; or toxic
agents may cause ESKD. A patient with more thanone of these risk
factors is at the greatest risk for developing ESKD. Therefore, the
patient with diabetesand hypertension is likely at highest risk
for ESKD.

A patient on the medical unit has a documented history of polycystic
kidney disease (PKD). Whatprinciple should guide the nurses care
of this patient?A) The disease is self-limiting and cysts
usually resolve spontaneously in the fifth or sixth decade
oflife.B) The patients disease is incurable and the nurses
interventions will be supportive.C) The patient will eventually
require surgical removal of his or her renal cysts.D) The
patient is likely to respond favorably to lithotripsy treatment of the cysts.

Ans: BFeedback:PKD is incurable and care focuses on
support and symptom control. It is not self-limiting and is
nottreated surgically or with lithotripsy.

A patient has been diagnosed with polycystic ovary syndrome (PCOS).
The nurse should encourageTest Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1083what
health promotion activity to address the patients hormone imbalance
and infertility?
A) Kegel exercisesB) Increased fluid intakeC) Weight
lossD) Topical antibiotics as ordered

Ans: CFeedback:Lifestyle modification is critical in the
treatment of PCOS, and weight management is part of thetreatment
plan. As little as a weight loss of 5% of total body weight can help
with hormone imbalanceand infertility. Antibiotics are
irrelevant, as PCOS does not have an infectious etiology. Fluid intake
andKegel exercises do not influence the course of the disease.

You are the nurse caring for a 77-year-old male patient who has been
involved in a motor vehicleaccident. You and your colleague note
that the patients labs indicate minimally elevated
serumcreatinine levels, which your colleague dismisses. What can
this increase in creatinine indicate in olderadults?A)
Substantially reduced renal functionB) Acute kidney
injuryC) Decreased cardiac outputD) Alterations in ratio
of body fluids to muscle mass

Ans: AFeedback:Normal physiologic changes of aging,
including reduced cardiac, renal, and respiratory function,
andreserve and alterations in the ratio of body fluids to muscle
mass, may alter the responses of elderlypeople to fluid and
electrolyte changes and acidbase disturbances. Renal function declines
with age, asdo muscle mass and daily exogenous creatinine
production. Therefore, high-normal and minimallyelevated serum
creatinine values may indicate substantially reduced renal function in
older adults. Acutekidney injury is likely to cause a more
significant increase in serum creatinine.

A patient is being treated in the ICU for neurogenic shock secondary
to a spinal cord injury. Despiteaggressive interventions, the
patients mean arterial pressure (MAP) has fallen to 55 mm Hg. The
nurseshould gauge the onset of acute kidney injury by referring
to what laboratory findings? Select all thatapply.A) Blood
urea nitrogen (BUN) levelB) Urine specific gravityC)
Alkaline phosphatase levelD) Creatinine levelE) Serum
albumin level

Ans: A, B, DFeedback:Acute kidney injury (AKI) is
characterized by an increase in BUN and serum creatinine levels, fluid
andelectrolyte shifts, acidbase imbalances, and a loss of the
renalhormonal regulation of BP. Urine specificgravity is also
affected. Alkaline phosphatase and albumin levels are related to
hepatic function.

The nurse is caring for acutely ill patient. What assessment finding
should prompt the nurse to informthe physician that the patient
may be exhibiting signs of acute kidney injury (AKI)?A) The
patient is complains of an inability to initiate voiding.B) The
patients urine is cloudy with a foul odor.C) The patients
average urine output has been 10 mL/hr for several hours.D) The
patient complains of acute flank pain.

Ans: CFeedback:Oliguria (<500 mL/d of urine) is the
most common clinical situation seen in AKI. Flank pain
andinability to initiate voiding are not characteristic of AKI.
Cloudy, foul-smelling urine is suggestive of aurinary tract infection.

The nurse is caring for a patient in acute kidney injury. Which of
the following complications wouldmost clearly warrant the
administration of polystyrene sulfonate (Kayexalate)?A)
HypernatremiaB) HypomagnesemiaC) HyperkalemiaD) Hypercalcemia

Ans: CFeedback:Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
1020Hyperkalemia, a common complication of acute kidney injury,
is life-threatening if immediate action isnot taken to reverse
it. The administration of polystyrene sulfonate reduces serum
potassium levels.

Renal failure can have prerenal, renal, or postrenal causes. A
patient with acute kidney injury is beingassessed to determine
where, physiologically, the cause is. If the cause is found to be
prerenal, whichcondition most likely caused it?A) Heart
failureB) GlomerulonephritisC) UreterolithiasisD)
Aminoglycoside toxicity

Ans: AFeedback:By causing inadequate renal perfusion,
heart failure can lead to prerenal failure. Glomerulonephritis
andaminoglycoside toxicity are renal causes, and
ureterolithiasis is a postrenal cause.

The nurse is caring for a patient in acute kidney injury. Which of
the following complications wouldmost clearly warrant the
administration of polystyrene sulfonate (Kayexalate)?A)
HypernatremiaB) HypomagnesemiaC) HyperkalemiaD) Hypercalcemia

Ans: CFeedback:Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
1020Hyperkalemia, a common complication of acute kidney injury,
is life-threatening if immediate action isnot taken to reverse
it. The administration of polystyrene sulfonate reduces serum
potassium levels.

A patient is scheduled for a CT scan of the abdomen with contrast.
The patient has a baseline creatininelevel of 2.3 mg/dL. In
preparing this patient for the procedure, the nurse anticipates what
orders?A) Monitor the patients electrolyte values every hour
before the procedure.B) Preprocedure hydration and
administration of acetylcysteineC) Hemodialysis immediately
prior to the CT scanTest Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1023D)
Obtain a creatinine clearance by collecting a 24-hour urine specimen.

Ans: BFeedback:Radiocontrast-induced nephropathy is a
major cause of hospital-acquired acute kidney injury.
Baselinelevels of creatinine greater than 2 mg/dL identify the
patient as being high risk. Preprocedure hydrationand
prescription of acetylcysteine (Mucomyst) the day prior to the test is
effective in prevention. Thenurse would not monitor the patients
electrolytes every hour preprocedure. Nothing in the
scenarioindicates the need for hemodialysis. A creatinine
clearance is not necessary prior to a CT scan withcontrast.

The nurse is caring for a patient in acute kidney injury. Which of
the following complications wouldmost clearly warrant the
administration of polystyrene sulfonate (Kayexalate)?
A) Hypernatremia B) Hypomagnesemia C)
Hyperkalemia D) Hypercalcemia

Ans: CFeedback:Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
1020Hyperkalemia, a common complication of acute kidney injury,
is life-threatening if immediate action isnot taken to reverse
it. The administration of polystyrene sulfonate reduces serum
potassium levels.

Renal failure can have prerenal, renal, or postrenal causes. A
patient with acute kidney injury is beingassessed to determine
where, physiologically, the cause is. If the cause is found to be
prerenal, whichcondition most likely caused it?A) Heart
failureB) GlomerulonephritisC) UreterolithiasisD)
Aminoglycoside toxicity

Ans: AFeedback:By causing inadequate renal perfusion,
heart failure can lead to prerenal failure. Glomerulonephritis
andaminoglycoside toxicity are renal causes, and
ureterolithiasis is a postrenal cause.

A patient is admitted to the ICU after a motor vehicle accident. On
the second day of the hospitaladmission, the patient develops
acute kidney injury. The patient is hemodynamically unstable, but
renalreplacement therapy is needed to manage the patients
hypervolemia and hyperkalemia. Which of thefollowing therapies
will the patients hemodynamic status best tolerate?A)
HemodialysisB) Peritoneal dialysisC) Continuous venovenous
hemodialysis (CVVHD)Test Bank - Brunner & Suddarth's
Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1024D) Plasmapheresis

Ans: CFeedback:CVVHD facilitates the removal of uremic
toxins and fluid. The hemodynamic effects of CVVHD areusually
mild in comparison to hemodialysis, so CVVHD is best tolerated by an
unstable patient.Peritoneal dialysis is not the best choice, as
the patient may have sustained abdominal injuries during
theaccident and catheter placement would be risky.
Plasmapheresis does not achieve fluid removal andelectrolyte balance.

A patient has presented with signs and symptoms that are
characteristic of acute kidney injury, butpreliminary assessment
reveals no obvious risk factors for this health problem. The nurse
shouldrecognize the need to interview the patient about what
topic?A) Typical dietB) Allergy statusC)
Psychosocial stressorsD) Current medication use

Ans: DFeedback:The kidneys are susceptible to the adverse
effects of medications because they are repeatedly exposed
tosubstances in the blood. Nephrotoxic medications are a more
likely cause of AKI than diet, allergies, orstress.

A patient experienced a 33% TBSA burn 72 hours ago. The nurse
observes that the patients hourly urineoutput has been steadily
increasing over the past 24 hours. How should the nurse best respond
to thisfinding?A) Obtain an order to reduce the rate of
the patients IV fluid infusion.B) Report the patients early
signs of acute kidney injury (AKI).C) Recognize that the patient
is experiencing an expected onset of diuresis.D) Administer
sodium chloride as ordered to compensate for this fluid loss.

Ans: CFeedback:As capillaries regain integrity, 48 or
more hours after the burn, fluid moves from the interstitial to
theintravascular compartment and diuresis begins. This is an
expected development and does not require areduction in the IV
infusion rate or the administration of NaCl. Diuresis is not
suggestive of AKI.

You are caring for a patient admitted with a diagnosis of acute
kidney injury. When you review yourpatients most recent
laboratory reports, you note that the patients magnesium levels are
high. You shouldprioritize assessment for which of the following
health problems?A) Diminished deep tendon reflexesB)
TachycardiaC) Cool, clammy skinD) Acute flank pain

Ans: AFeedback:To gauge a patients magnesium status, the
nurse should check deep tendon reflexes. If the reflex isabsent,
this may indicate high serum magnesium. Tachycardia, flank pain, and
cool, clammy skin are nottypically associated with hypermagnesemia.

New Book- Giddens = none

ignatavicius 9th ed

A nurse assesses a client with polycystic kidney disease (PKD). Which
assessment finding should alert thenurse to immediately contact
the health care provider?a. Flank painb. Periorbital
edemac. Bloody and cloudy urined. Enlarged abdomen

ANS: BPeriorbital edema would not be a finding related to PKD
and should be investigated further. Flank pain and adistended or
enlarged abdomen occur in PKD because the kidneys enlarge and displace
other organs. Urine canbe bloody or cloudy as a result of cyst
rupture or infection.DIF: Applying/Application REF:
1374KEY: Polycystic kidney diseaseMSC: Integrated Process:
Nursing Process: AssessmentNOT: Client Needs Category:
Physiological Integrity: Physiological Adaptation

A nurse cares for a client with autosomal dominant polycystic kidney
disease (ADPKD). The client asks,Will my children develop this
disease? How should the nurse respond?a. No genetic link is
known, so your children are not at increased risk.b. Your sons
will develop this disease because it has a sex-linked gene.c.
Only if both you and your spouse are carriers of this disease.d.
Each of your children has a 50% risk of having ADPKD.

ANS: DChildren whose parent has the autosomal dominant form of
PKD have a 50% chance of inheriting the gene thatcauses the
disease. ADPKD is transmitted as an autosomal dominant trait and
therefore is not gender specific.Both parents do not need to
have this disorder.DIF: Understanding/Comprehension REF:
1374KEY: Polycystic kidney disease| genetics MSC: Integrated
Process: Teaching/LearningNOT: Client Needs Category: Safe and
Effective Care Environment: Management of Care

After teaching a client with early polycystic kidney disease (PKD)
about nutritional therapy, the nurseassesses the clients
understanding. Which statement made by the client indicates a correct
understanding of theteaching?a. I will take a laxative
every night before going to bed.b. I must increase my intake of
dietary fiber and fluids.c. I shall only use salt when I am
cooking my own food.d. Ill eat white bread to minimize
gastrointestinal gas.

ANS: BClients with PKD often have constipation, which can be
managed with increased fiber, exercise, and drinkingplenty of
water. Laxatives should be used cautiously. Clients with PKD should be
on a restricted salt diet,which includes not cooking with salt.
White bread has a low fiber count and would not be included in a
highfiberdiet.DIF: Applying/Application REF:
1375KEY: Polycystic kidney disease| nutritional
requirementsMSC: Integrated Process: Nursing Process:
EvaluationNOT: Client Needs Category: Physiological Integrity:
Basic Care and Comfort

A nurse assesses a client who has a family history of polycystic
kidney disease (PKD). For which clinicalmanifestations should
the nurse assess? (Select all that apply.)a. Nocturiab.
Flank painc. Increased abdominal girthd. Dysuriae.
Hematuriaf. Diarrhea

ANS: B, C, EClients with PKD experience abdominal distention
that manifests as flank pain and increased abdominal
girth.Bloody urine is also present with tissue damage secondary
to PKD. Clients with PKD often experienceconstipation, but would
not report nocturia or dysuria.DIF: Remembering/Knowledge REF:
1374KEY: Polycystic kidney disease| assessment/diagnostic
examinationMSC: Integrated Process: Nursing Process:
AssessmentNOT: Client Needs Category: Physiological Integrity:
Physiological Adaptation

A nurse teaches a client with polycystic kidney disease (PKD). Which
statements should the nurse include inthis clients discharge
teaching? (Select all that apply.)a. Take your blood pressure
every morning.b. Weigh yourself at the same time each
day.c. Adjust your diet to prevent diarrhea.d. Contact
your provider if you have visual disturbances.e. Assess your
urine for renal stones.

ANS: A, B, DA client who has PKD should measure and record his
or her blood pressure and weight daily, limit salt intake,and
adjust dietary selections to prevent constipation. The client should
notify the provider if urine smells foulor has blood in it, as
these are signs of a urinary tract infection or glomerular injury. The
client should alsonotify the provider if visual disturbances are
experienced, as this is a sign of a possible berry aneurysm,
whichTest Bank - Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care 9e 573is a complication of
PKD. Diarrhea and renal stones are not manifestations or complications
of PKD;therefore, teaching related to these concepts would be
inappropriate.DIF: Applying/Application REF: 1375KEY:
Polycystic kidney disease MSC: Integrated Process:
Teaching/LearningNOT: Client Needs Category: Safe and Effective
Care Environment: Management of Care

The nurse is assessing a client with a diagnosis of pre-renal acute
kidney injury (AKI). Which conditionwould the nurse expect to
find in the clients recent history?a. Pyelonephritisb.
Myocardial infarctionc. Bladder cancerd. Kidney stones

ANS: BPre-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 kidneystones are post-renal causes of AKI
related to urine flow obstruction.DIF:
Understanding/Comprehension REF: 1391KEY: Renal system|
pathophysiology| nursing analysisMSC: Integrated Process:
Nursing Process: AnalysisNOT: Client Needs Category:
Physiological Integrity: Physiological Adaptation

A client with acute kidney injury has a blood pressure of 76/55 mm
Hg. The health care provider ordered1000 mL of normal saline to
be infused over 1 hour to maintain perfusion. The client is starting
to developshortness of breath. What is the nurses priority
action?a. Calculate the mean arterial pressure (MAP).b.
Ask for insertion of a pulmonary artery catheter.c. Take the
clients pulse.d. Slow down the normal saline infusion.

ANS: DThe nurse should assess that the client could be
developing fluid overload and respiratory distress and slowdown
the normal saline infusion. The calculation of the MAP also reflects
perfusion. The insertion of apulmonary artery catheter would
evaluate the clients hemodynamic status, but this should not be the
initialaction by the nurse. Vital signs are also important after
adjusting the intravenous infusion.DIF: Applying/Application
REF: 1395KEY: Renal system| hemodynamic status| nursing
interventionMSC: Integrated Process: Nursing Process:
ImplementationNOT: Client Needs Category: Safe and Effective
Care Environment: Management of Care

A client has a serum potassium level of 6.5 mmol/L, a serum
creatinine level of 2 mg/dL, and a urine outputof 350 mL/day.
What is the best action by the nurse?a. Place the client on a
cardiac monitor immediately.b. Teach the client to limit
high-potassium foods.c. Continue to monitor the clients intake
and output.d. Ask to have the laboratory redraw the blood specimen.

ANS: AThe priority action by the nurse should be to check the
cardiac status with a monitor. High potassium levelscan lead to
dysrhythmias. The other choices are logical nursing interventions for
acute kidney injury but notthe best immediate action.DIF:
Applying/Application REF: 1400KEY: Renal system| electrolyte
imbalance| nursing interventionMSC: Integrated Process: Nursing
Process: ImplementationNOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation

A client in the intensive care unit is started on continuous
venovenous hemofiltration (CVVH). Whichfinding is the cause of
immediate action by the nurse?a. Blood pressure of 76/58 mm
Hgb. Sodium level of 138 mEq/Lc. Potassium level of 5.5
mEq/Ld. Pulse rate of 90 beats/min

ANS: AHypotension can be a problem with CVVH if replacement
fluid does not provide enough volume to maintainblood pressure.
The specially trained nurse needs to monitor for ongoing fluid and
electrolyte replacement. Thesodium level is normal and the
potassium level is slightly elevated, which could be normal findings
forsomeone with acute kidney injury. A pulse rate of 90
beats/min is normal.DIF: Applying/Application REF:
1397KEY: Renal system| dialysis| nursing interventionMSC:
Integrated Process: Nursing Process: ImplementationNOT: Client
Needs Category: Safe and Effective Care Environment: Management of Care

The nurse is caring for five clients on the medical-surgical unit.
Which clients would the nurse consider tobe at risk for
post-renal acute kidney injury (AKI)? (Select all that apply.)a.
Man with prostate cancerb. Woman with blood clots in the urinary
tractc. Client with ureterolithiasisd. Firefighter with
severe burnse. Young woman with lupus

ANS: A, B, CUrine flow obstruction, such as prostate cancer,
blood clots in the urinary tract, and kidney
stones(ureterolithiasis), causes post-renal AKI. Severe burns
would be a pre-renal cause. Lupus would be anintrarenal cause
for AKI.DIF: Understanding/Comprehension REF: 1392KEY:
Renal system| pathophysiologyMSC: Integrated Process: Nursing
Process: AnalysisNOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation

A client is hospitalized in the oliguric phase of acute kidney injury
(AKI) and is receiving tube feedings. Thenurse is teaching the
clients spouse about the kidney-specific formulation for the enteral
solution compared tostandard formulas. What components should be
discussed in the teaching plan? (Select all that apply.)a. Lower
sodiumb. Higher calciumc. Lower potassiumd. Higher
phosphoruse. Higher calories

ANS: A, C, EMany clients with AKI are too ill to meet caloric
goals and require tube feedings with kidney-specific
formulasthat are lower in sodium, potassium, and phosphorus, and
higher in calories than are standard formulas.DIF:
Remembering/Knowledge REF: 1396KEY: Renal system| nutritional
requirements| patient educationMSC: Integrated Process:
Teaching/LearningNOT: Client Needs Category: Health Promotion
and Maintenance

A client in the intensive care unit with acute kidney injury (AKI)
must maintain a mean arterial pressure(MAP) of 65 mm Hg to
promote kidney perfusion. What is the clients MAP if the blood
pressure is 98/50 mmHg? (Record your answer using a whole
number.) _____ mm Hg

ANS:66 mm HgTest Bank - Medical-Surgical Nursing:
Concepts for Interprofessional Collaborative Care 9e 585DIF:
Applying/Application REF: 1395KEY: Renal system| perfusion| mean
arterial blood pressure| calculationMSC: Integrated Process:
Nursing Process: ImplementationNOT: Client Needs Category: Safe
and Effective Care Environment: Safety and Infection Control

new book

lewis 9th ed

A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and
confused, with amarkedly distended bladder. Which intervention
prescribed by the health care provider should thenurse implement
first?a. Insert a urinary retention catheter.b. Schedule
an intravenous pyelogram (IVP).c. Draw blood for a serum
creatinine level.d. Administer lorazepam (Ativan) 0.5 mg PO.

ANS: AThe patient�s history and clinical manifestations are
consistent with acute urinary retention, and thepriority action
is to relieve the retention by catheterization. The BUN and creatinine
measurements can beobtained after the catheter is inserted. The
patient�s agitation may resolve once the bladder distention
iscorrected, and sedative drugs should be used cautiously in
older patients. The IVP is an appropriate testbut does not need
to be done urgently.DIF: Cognitive Level: Apply (application)
REF: 1092OBJ: Special Questions: Prioritization TOP: Nursing
Process: ImplementationMSC: NCLEX: Physiological Integrity

After change-of-shift report, which patient should the nurse assess
first?a. Patient with a urethral stricture who has not voided
for 12 hoursb. Patient who has cloudy urine after orthotopic
bladder reconstructionc. Patient with polycystic kidney disease
whose blood pressure is 186/98 mm Hgd. Patient who voided bright
red urine immediately after returning from lithotripsy

ANS: AThe patient information suggests acute urinary retention,
a medical emergency. The nurse will need toassess the patient
and consider whether to insert a retention catheter. The other
patients will also beassessed, but their findings are consistent
with their diagnoses and do not require immediate assessmentor
possible intervention.DIF: Cognitive Level: Analyze
(analysis)OBJ: Special Questions: Prioritization; Multiple
Patients TOP: Nursing Process: PlanningMSC: NCLEX: Physiological Integrity

A 28-year-old male patient is diagnosed with polycystic kidney
disease. Whichinformation is most appropriate for the nurse to
include in teaching at this time?a. Complications of renal
transplantationb. Methods for treating severe chronic
painc. Discussion of options for genetic counselingd.
Differences between hemodialysis and peritoneal dialysis

ANS: CBecause a 28-year-old patient may be considering having
children, the nurse should include informationabout genetic
counseling when teaching the patient. The well-managed patient will
not need to choosebetween hemodialysis and peritoneal dialysis
or know about the effects of transplantation for many
years.There is no indication that the patient has chronic
pain.DIF: Cognitive Level: Apply (application) REF:
1083TOP: Nursing Process: Implementation MSC: NCLEX: Health
Promotion andMaintenance

A 32-year-old patient with a history of polycystic kidney disease is
admitted to thesurgical unit after having shoulder surgery.
Which of the routine postoperative orders is mostimportant for
the nurse to discuss with the health care provider?a. Infuse 5%
dextrose in normal saline at 75 mL/hr.b. Order regular diet
after patient is awake and alert.c. Give ketorolac (Toradol) 10
mg PO PRN for pain.d. Draw blood urea nitrogen (BUN) and
creatinine in 2 hours.

ANS: CThe nonsteroidal antiinflammatory drugs (NSAIDs) should
be avoided in patients with decreased renalfunction because
nephrotoxicity is a potential adverse effect. The other orders do not
need anyclarification or change.DIF: Cognitive Level:
Apply (application) REF: 1075TOP: Nursing Process:
Implementation MSC: NCLEX: Physiological Integrity

After change-of-shift report, which patient should the nurse assess
first?a. Patient with a urethral stricture who has not voided
for 12 hoursb. Patient who has cloudy urine after orthotopic
bladder reconstructionc. Patient with polycystic kidney disease
whose blood pressure is 186/98 mm Hgd. Patient who voided bright
red urine immediately after returning from lithotripsy

ANS: AThe patient information suggests acute urinary retention,
a medical emergency. The nurse will need toassess the patient
and consider whether to insert a retention catheter. The other
patients will also beassessed, but their findings are consistent
with their diagnoses and do not require immediate assessmentor
possible intervention.DIF: Cognitive Level: Analyze
(analysis)OBJ: Special Questions: Prioritization; Multiple
Patients TOP: Nursing Process: PlanningMSC: NCLEX: Physiological Integrity

A 37-year-old female patient is hospitalized with acute kidney injury
(AKI). Whichinformation will be most useful to the nurse in
evaluating improvement in kidney function?a. Urine
volumeb. Creatinine levelc. Glomerular filtration rate
(GFR)d. Blood urea nitrogen (BUN) level

ANS: CGFR is the preferred method for evaluating kidney
function. BUN levels can fluctuate based on factorssuch as fluid
volume status and protein intake. Urine output can be normal or high
in patients with AKIand does not accurately reflect kidney
function. Creatinine alone is not an accurate reflection of
renalfunction.DIF: Cognitive Level: Apply (application)
REF: 1112TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity

Which intervention will be included in the plan of care for a male
patient with acutekidney injury (AKI) who has a temporary
vascular access catheter in the left femoral vein?a. Start
continuous pulse oximetry.b. Restrict physical activity to bed
rest.c. Restrict the patient�s oral protein intake.d.
Discontinue the urethral retention catheter

ANS: BThe patient with a femoral vein catheter must be on bed
rest to prevent trauma to the vein. Protein intakeis likely to
be increased when the patient is receiving dialysis. The retention
catheter is likely to remain inplace because accurate
measurement of output will be needed. There is no indication that the
patientneeds continuous pulse oximetry.DIF: Cognitive
Level: Apply (application) REF: 1120TOP: Nursing Process:
Planning MSC: NCLEX: Physiological Integrity

A 62-year-old female patient has been hospitalized for 8 days with
acute kidney injury(AKI) caused by dehydration. Which
information will be most important for the nurse to report tothe
health care provider?a. The creatinine level is 3.0
mg/dL.b. Urine output over an 8-hour period is 2500 mL.c.
The blood urea nitrogen (BUN) level is 67 mg/dL.d. The
glomerular filtration rate is <30 mL/min/1.73m2.

ANS: BThe high urine output indicates a need to increase fluid
intake to prevent hypovolemia. The otherinformation is typical
of AKI and will not require a change in therapy.DIF: Cognitive
Level: Apply (application) REF: 1104OBJ: Special Questions:
Prioritization TOP: Nursing Process: AssessmentMSC: NCLEX:
Physiological Integrity

A patient with acute kidney injury (AKI) has longer QRS intervals on
theelectrocardiogram (ECG) than were noted on the previous
shift. Which action should the nurse takefirst?a. Notify
the patient�s health care provider.b. Document the QRS interval
measurement.c. Check the medical record for most recent
potassium level.d. Check the chart for the patient�s current
creatinine level.

ANS: CThe increasing QRS interval is suggestive of
hyperkalemia, so the nurse should check the most recentpotassium
and then notify the patient�s health care provider. The BUN and
creatinine will be elevated in apatient with AKI, but they would
not directly affect the electrocardiogram (ECG). Documentation of
theQRS interval is also appropriate, but interventions to
decrease the potassium level are needed to
preventlife-threatening dysrhythmias.DIF: Cognitive Level:
Apply (application) REF: 1112OBJ: Special Questions:
Prioritization TOP: Nursing Process: ImplementationMSC: NCLEX:
Physiological Integrity

A 42-year-old patient admitted with acute kidney injury due to
dehydration hasoliguria, anemia, and hyperkalemia. Which
prescribed actions should the nurse take first?a. Insert a
urinary retention catheter.b. Place the patient on a cardiac
monitor.c. Administer epoetin alfa (Epogen, Procrit).d.
Give sodium polystyrene sulfonate (Kayexalate).

ANS: BBecause hyperkalemia can cause fatal cardiac
dysrhythmias, the initial action should be to monitor thecardiac
rhythm. Kayexalate and Epogen will take time to correct the
hyperkalemia and anemia. Thecatheter allows monitoring of the
urine output but does not correct the cause of the renal
failure.DIF: Cognitive Level: Apply (application) REF: 1104 |
1109OBJ: Special Questions: Prioritization TOP: Nursing Process:
ImplementationMSC: NCLEX: Physiological Integrity