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

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PKD & AKI
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1

New Book

Brunner & Suddarth 14th ed

2

The nurse is assessing a patients bladder by percussion. The nurse elicits dullness after the patient has
voided. 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: A
Feedback:
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 disease
or hydronephrosis and is not related to bladder fullness. Dehydration and ureteral obstruction are not
related to bladder fullness; in fact, these conditions result in decreased flow of urine to the bladder.

3

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

Ans: B
Feedback:
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 than
one of these risk factors is at the greatest risk for developing ESKD. Therefore, the patient with diabetes
and hypertension is likely at highest risk for ESKD.

4

A patient on the medical unit has a documented history of polycystic kidney disease (PKD). What
principle 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 of
life.
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: B
Feedback:
PKD is incurable and care focuses on support and symptom control. It is not self-limiting and is not
treated surgically or with lithotripsy.

5

A patient has been diagnosed with polycystic ovary syndrome (PCOS). The nurse should encourage
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1083
what health promotion activity to address the patients hormone imbalance and infertility?

A) Kegel exercises
B) Increased fluid intake
C) Weight loss
D) Topical antibiotics as ordered

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

6

You are the nurse caring for a 77-year-old male patient who has been involved in a motor vehicle
accident. You and your colleague note that the patients labs indicate minimally elevated serum
creatinine levels, which your colleague dismisses. What can this increase in creatinine indicate in older
adults?
A) Substantially reduced renal function
B) Acute kidney injury
C) Decreased cardiac output
D) Alterations in ratio of body fluids to muscle mass

Ans: A
Feedback:
Normal physiologic changes of aging, including reduced cardiac, renal, and respiratory function, and
reserve and alterations in the ratio of body fluids to muscle mass, may alter the responses of elderly
people to fluid and electrolyte changes and acidbase disturbances. Renal function declines with age, as
do muscle mass and daily exogenous creatinine production. Therefore, high-normal and minimally
elevated serum creatinine values may indicate substantially reduced renal function in older adults. Acute
kidney injury is likely to cause a more significant increase in serum creatinine.

7

A patient is being treated in the ICU for neurogenic shock secondary to a spinal cord injury. Despite
aggressive interventions, the patients mean arterial pressure (MAP) has fallen to 55 mm Hg. The nurse
should gauge the onset of acute kidney injury by referring to what laboratory findings? Select all that
apply.
A) Blood urea nitrogen (BUN) level
B) Urine specific gravity
C) Alkaline phosphatase level
D) Creatinine level
E) Serum albumin level

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

8

The nurse is caring for acutely ill patient. What assessment finding should prompt the nurse to inform
the 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: C
Feedback:
Oliguria (<500 mL/d of urine) is the most common clinical situation seen in AKI. Flank pain and
inability to initiate voiding are not characteristic of AKI. Cloudy, foul-smelling urine is suggestive of a
urinary tract infection.

9

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

Ans: C
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1020
Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is
not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.

10

Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being
assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which
condition most likely caused it?
A) Heart failure
B) Glomerulonephritis
C) Ureterolithiasis
D) Aminoglycoside toxicity

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

11

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

Ans: C
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1020
Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is
not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.

12

A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine
level 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 acetylcysteine
C) Hemodialysis immediately prior to the CT scan
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1023
D) Obtain a creatinine clearance by collecting a 24-hour urine specimen.

Ans: B
Feedback:
Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline
levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration
and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The
nurse would not monitor the patients electrolytes every hour preprocedure. Nothing in the scenario
indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with
contrast.

13

The nurse is caring for a patient in acute kidney injury. Which of the following complications would
most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?

  1. A) Hypernatremia
  2. B) Hypomagnesemia
  3. C) Hyperkalemia
  4. D) Hypercalcemia

Ans: C
Feedback:
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1020
Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is
not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.

14

Renal failure can have prerenal, renal, or postrenal causes. A patient with acute kidney injury is being
assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which
condition most likely caused it?
A) Heart failure
B) Glomerulonephritis
C) Ureterolithiasis
D) Aminoglycoside toxicity

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

15

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

Ans: C
Feedback:
CVVHD facilitates the removal of uremic toxins and fluid. The hemodynamic effects of CVVHD are
usually 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 the
accident and catheter placement would be risky. Plasmapheresis does not achieve fluid removal and
electrolyte balance.

16

A patient has presented with signs and symptoms that are characteristic of acute kidney injury, but
preliminary assessment reveals no obvious risk factors for this health problem. The nurse should
recognize the need to interview the patient about what topic?
A) Typical diet
B) Allergy status
C) Psychosocial stressors
D) Current medication use

Ans: D
Feedback:
The kidneys are susceptible to the adverse effects of medications because they are repeatedly exposed to
substances in the blood. Nephrotoxic medications are a more likely cause of AKI than diet, allergies, or
stress.

17

A patient experienced a 33% TBSA burn 72 hours ago. The nurse observes that the patients hourly urine
output has been steadily increasing over the past 24 hours. How should the nurse best respond to this
finding?
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: C
Feedback:
As capillaries regain integrity, 48 or more hours after the burn, fluid moves from the interstitial to the
intravascular compartment and diuresis begins. This is an expected development and does not require a
reduction in the IV infusion rate or the administration of NaCl. Diuresis is not suggestive of AKI.

18

You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your
patients most recent laboratory reports, you note that the patients magnesium levels are high. You should
prioritize assessment for which of the following health problems?
A) Diminished deep tendon reflexes
B) Tachycardia
C) Cool, clammy skin
D) Acute flank pain

Ans: A
Feedback:
To gauge a patients magnesium status, the nurse should check deep tendon reflexes. If the reflex is
absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not
typically associated with hypermagnesemia.

19

New Book- Giddens = none

ignatavicius 9th ed

20

A nurse assesses a client with polycystic kidney disease (PKD). Which assessment finding should alert the
nurse to immediately contact the health care provider?
a. Flank pain
b. Periorbital edema
c. Bloody and cloudy urine
d. Enlarged abdomen

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

21

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: D
Children whose parent has the autosomal dominant form of PKD have a 50% chance of inheriting the gene that
causes 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: 1374
KEY: Polycystic kidney disease| genetics MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

22

After teaching a client with early polycystic kidney disease (PKD) about nutritional therapy, the nurse
assesses the clients understanding. Which statement made by the client indicates a correct understanding of the
teaching?
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: B
Clients with PKD often have constipation, which can be managed with increased fiber, exercise, and drinking
plenty 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 highfiber
diet.
DIF: Applying/Application REF: 1375
KEY: Polycystic kidney disease| nutritional requirements
MSC: Integrated Process: Nursing Process: Evaluation
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

23

A nurse assesses a client who has a family history of polycystic kidney disease (PKD). For which clinical
manifestations should the nurse assess? (Select all that apply.)
a. Nocturia
b. Flank pain
c. Increased abdominal girth
d. Dysuria
e. Hematuria
f. Diarrhea

ANS: B, C, E
Clients 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 experience
constipation, but would not report nocturia or dysuria.
DIF: Remembering/Knowledge REF: 1374
KEY: Polycystic kidney disease| assessment/diagnostic examination
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

24

A nurse teaches a client with polycystic kidney disease (PKD). Which statements should the nurse include in
this 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, D
A 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 foul
or has blood in it, as these are signs of a urinary tract infection or glomerular injury. The client should also
notify the provider if visual disturbances are experienced, as this is a sign of a possible berry aneurysm, which
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 573
is 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: 1375
KEY: Polycystic kidney disease MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

25

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 clients recent history?
a. Pyelonephritis
b. Myocardial infarction
c. Bladder cancer
d. 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: 1391
KEY: Renal system| pathophysiology| nursing analysis
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

26

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered
1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop
shortness 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: D
The nurse should assess that the client could be developing fluid overload and respiratory distress and slow
down the normal saline infusion. The calculation of the MAP also reflects perfusion. The insertion of a
pulmonary artery catheter would evaluate the clients hemodynamic status, but this should not be the initial
action by the nurse. Vital signs are also important after adjusting the intravenous infusion.
DIF: Applying/Application REF: 1395
KEY: Renal system| hemodynamic status| nursing intervention
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

27

A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output
of 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: A
The priority action by the nurse should be to check the cardiac status with a monitor. High potassium levels
can lead to dysrhythmias. The other choices are logical nursing interventions for acute kidney injury but not
the best immediate action.
DIF: Applying/Application REF: 1400
KEY: Renal system| electrolyte imbalance| nursing intervention
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

28

A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which
finding is the cause of immediate action by the nurse?
a. Blood pressure of 76/58 mm Hg
b. Sodium level of 138 mEq/L
c. Potassium level of 5.5 mEq/L
d. Pulse rate of 90 beats/min

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

29

The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to
be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)
a. Man with prostate cancer
b. Woman with blood clots in the urinary tract
c. Client with ureterolithiasis
d. Firefighter with severe burns
e. Young woman with lupus

ANS: A, B, C
Urine 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 an
intrarenal cause for AKI.
DIF: Understanding/Comprehension REF: 1392
KEY: Renal system| pathophysiology
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

30

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The
nurse is teaching the clients spouse about the kidney-specific formulation for the enteral solution compared to
standard formulas. What components should be discussed in the teaching plan? (Select all that apply.)
a. Lower sodium
b. Higher calcium
c. Lower potassium
d. Higher phosphorus
e. Higher calories

ANS: A, C, E
Many clients with AKI are too ill to meet caloric goals and require tube feedings with kidney-specific formulas
that are lower in sodium, potassium, and phosphorus, and higher in calories than are standard formulas.
DIF: Remembering/Knowledge REF: 1396
KEY: Renal system| nutritional requirements| patient education
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

31

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 mm
Hg? (Record your answer using a whole number.) _____ mm Hg

ANS:
66 mm Hg
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 585
DIF: Applying/Application REF: 1395
KEY: Renal system| perfusion| mean arterial blood pressure| calculation
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

32

new book

lewis 9th ed

33

A 76-year-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a
markedly distended bladder. Which intervention prescribed by the health care provider should the
nurse 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: A
The patient’s history and clinical manifestations are consistent with acute urinary retention, and the
priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be
obtained after the catheter is inserted. The patient’s agitation may resolve once the bladder distention is
corrected, and sedative drugs should be used cautiously in older patients. The IVP is an appropriate test
but does not need to be done urgently.
DIF: Cognitive Level: Apply (application) REF: 1092
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

34

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

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

35

A 28-year-old male patient is diagnosed with polycystic kidney disease. Which
information is most appropriate for the nurse to include in teaching at this time?
a. Complications of renal transplantation
b. Methods for treating severe chronic pain
c. Discussion of options for genetic counseling
d. Differences between hemodialysis and peritoneal dialysis

ANS: C
Because a 28-year-old patient may be considering having children, the nurse should include information
about genetic counseling when teaching the patient. The well-managed patient will not need to choose
between 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: 1083
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and
Maintenance

36

A 32-year-old patient with a history of polycystic kidney disease is admitted to the
surgical unit after having shoulder surgery. Which of the routine postoperative orders is most
important 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: C
The nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided in patients with decreased renal
function because nephrotoxicity is a potential adverse effect. The other orders do not need any
clarification or change.
DIF: Cognitive Level: Apply (application) REF: 1075
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

37

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

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

38

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

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

39

Which intervention will be included in the plan of care for a male patient with acute
kidney 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: B
The patient with a femoral vein catheter must be on bed rest to prevent trauma to the vein. Protein intake
is likely to be increased when the patient is receiving dialysis. The retention catheter is likely to remain in
place because accurate measurement of output will be needed. There is no indication that the patient
needs continuous pulse oximetry.
DIF: Cognitive Level: Apply (application) REF: 1120
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

40

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

41

A patient with acute kidney injury (AKI) has longer QRS intervals on the
electrocardiogram (ECG) than were noted on the previous shift. Which action should the nurse take
first?
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: C
The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent
potassium and then notify the patient’s health care provider. The BUN and creatinine will be elevated in a
patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the
QRS interval is also appropriate, but interventions to decrease the potassium level are needed to prevent
life-threatening dysrhythmias.
DIF: Cognitive Level: Apply (application) REF: 1112
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

42

A 42-year-old patient admitted with acute kidney injury due to dehydration has
oliguria, 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: B
Because hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the
cardiac rhythm. Kayexalate and Epogen will take time to correct the hyperkalemia and anemia. The
catheter allows monitoring of the urine output but does not correct the cause of the renal failure.
DIF: Cognitive Level: Apply (application) REF: 1104 | 1109
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity