Unit1: Ch 34- Acute Kidney Injury and Chronic Kidney Disease (Porth 5th Ed) Flashcards
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.
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.
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.
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 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.
A 35-year-old female ultramarathon runner is admitted to the hospital following a
day-long, 50-mile race because her urinary volume is drastically decreased and her urine
is dark red. Tests indicate that she is in the initiating phase of acute tubular necrosis.
Why is her urine red?
A) Hematuria
B) Hemoglobinuria
C) Myoglobinuria
D) Kidney bleeding
Ans: C
Feedback:
Myoglobinuria, which can cause acute tubular necrosis via intratubular obstruction,
involves the leaching of myoglobin from skeletal muscle into the urine, bypassing the
usual filtration by the glomerulus. Excess exercise and muscle trauma can contribute to
this. While both hemoglobinuria and myoglobinuria discolor the urine, hemoglobinuria
results from hemolysis following a reaction to a blood transfusion, whereas
myoglobinuria involves muscle damage.
Following the diagnosis of acute renal failure, the nurse knows that one of the earliest
manifestations of residual tubular damage is which of the following lab/diagnostic
results?
A) Elevated blood urea nitrogen (BUN)
B) Serum creatinine elevation
C) Inability to concentrate urine
D) Reduced glomerular filtration rate
Ans: A
Feedback:
Urine tests that measure urine osmolality, urinary sodium concentration, and fractional
excretion of sodium help differentiate prerenal azotemia, in which the reabsorptive
capacity of the tubular cells is maintained, from tubular necrosis, in which these
functions are lost. One of the earliest manifestations of tubular damage is the inability to
concentrate urine. Conventional markers of serum creatinine and urea nitrogen,
fractional secretion of sodium to assess glomerular filtration rate (GFR), and urine
output do not manifest for 1 to 2 days after the acute renal failure has begun.
A family physician is providing care for a 61-year-old obese male who has a history of
diabetes and hypertension. Blood work has indicated that the man has a GFR of 51
mL/minute with elevated serum creatinine levels. Which of the following statements
will the physician most likely provide the client in light of these results?
A) “We will regularly monitor your kidney function, but most likely your kidneys
will be able to compensate on their own and intervention is not required.”
B) “You likely have chronic kidney disease, and there may be urine in your blood
until it is controlled.”
C) “Your chronic kidney disease has likely been caused by your diabetes and high
blood pressure.”
D) “You’re in kidney failure, and I’ll be starting dialysis treatment immediately.”
Ans: C
Feedback:
Diabetes and hypertension are conditions that can cause chronic kidney disease (CKD).
While the kidneys do have a remarkable ability to compensate for impaired function,
this fact does not mean that treatment would not be undertaken. Hematuria is not a
common manifestation of CKD, and the client’s GFR of 51 mL/minute does not indicate
kidney failure or the need for dialysis.
A nurse is collecting a urine specimen prior to measuring the albumin level in a client’s
urine. A colleague questions the rationale for the test, stating, “I thought albumin was
related to liver function, not kidney function.” How can the nurse best respond to this
statement?
A) “Urine should normally be free of any proteins, and albumin is one of the more
common proteins to be excreted in chronic renal failure.”
B) “Urine albumin levels are useful for diagnosing diabetic kidney disease.”
C) “A urine dipstick test will tell us exactly how much albumin is being spilled by
the client’s kidneys.”
D) “A urine test for albumin allows us to estimate the client’s GFR quite accurately.”
Ans: B
Feedback:
In clients with diabetes, albumin tests are useful adjunctive test of nephron injury and
repair. Urine is not normally completely free of proteins, and a urine dipstick does not
allow for the quantification of how much albumin is in a sample. Albumin tests do not
allow for an accurate indirect indication of GFR.
Which of the following clinical manifestations would lead the nurse to suspect the renal
failure patient is developing uremia? Select all that apply.
A) Weakness and fatigue
B) Lethargy and confusion
C) Extreme itching
D) Blood in urine
E) Urine smell in the stool
Ans: A, B, C
Feedback:
Uremia affects all body systems. The symptoms at the onset include weakness, fatigue,
nausea, and apathy. These are subtle signs. More severe symptoms include extreme
weakness, frequent vomiting, lethargy, and confusion.
A hospital client with a diagnosis of chronic renal failure has orders for measurement of
her serum electrolyte levels three times per week. Which of the following statements
best captures the relationship between renal failure and sodium regulation?
A) Clients with advanced renal failure are prone to hyponatremia because of
impaired tubular reabsorption.
B) Renal clients often require a sodium-restricted diet to minimize the excretion load
on remaining nephrons.
C) Clients with renal failure often maintain high sodium levels because of decreased
excretion.
D) Restricting sodium intake helps to preserve nephron function and has the
additional benefit of lowering blood pressure.
Ans: A
Feedback:
The compromised ability of the tubular nephrons to reabsorb sodium predisposes renal
clients to low serum sodium levels. A sodium restriction is thus not normally indicated.
Which of the following clients’ diagnostic blood work is most suggestive of chronic
kidney disease (CKD)?
A) A client with high pH; low levels of calcium; and low levels of phosphate
B) A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid
hormone (PTH) levels
C) A client with low bone density; low levels of calcium; and low levels of
phosphate
D) A client with low potassium levels; low calcitriol levels; and increased PTH levels
Ans: B
Feedback:
CKD is associated with low vitamin D and calcitriol levels, which induces increased
PTH production. CKD is also associated with acidosis (low pH), high levels of
phosphate, and hyperkalemia.
Which of the following medications would the nurse anticipate being prescribed for the
renal failure patient who has hyperphosphatemia?
A) Vitamin D (calcitriol)
B) Calcium carbonate
C) Levothyroxine (Synthroid)
D) Sensipar (Cinacalcet)
Ans: B
Feedback:
Phosphate-binding antacids (aluminum salts, calcium carbonate, or calcium acetate)
may be prescribed to decrease the absorption of phosphate from the GI tract.
To maintain hematocrit levels in people with kidney failure, the nurse should be
prepared to
A) arrange for frequent blood transfusions in an outpatient clinic.
B) administer iron dextran intravenously.
C) administer a subcutaneous injection of recombinant human erythropoietin
(rhEPO).
D) administer prenatal vitamins twice a day.
Ans: C
Feedback:
Recombinant human erythropoietin (rhEPO) helps maintain hematocrit levels in people
with kidney failure. Secondary benefits include improvement in appetite, energy level,
sexual function, skin color, anNdUhRaiSr IanNdGnTaiBl .grCoOwMth, and reduced cold intolerance.
Blood transfusion is a treatment if symptomatic with low hemoglobin; however, they try
to prevent this by giving EPO or IV iron dextran if there is severe iron deficiency
anemia. Prenatal vitamins are high in vitamins but not helpful to renal failure patients.
A nurse educator is performing client education with a 51-year-old man who has been
recently diagnosed with chronic kidney disease. Which of the following statements by
the client would the nurse most likely want to correct or clarify?
A) “I’ll be prone to anemia, since I’m not producing as much of the hormone that
causes my bones to produce red blood cells.”
B) “My heart rate might go up because of my kidney disease, and my blood might be
a lot thinner than it should be.”
C) “My kidney problems increase my chance of developing high blood pressure or
diabetes.”
D) “I’ll have a risk of either bleeding too easily or possibly clotting too quickly,
though dialysis can help minimize these effects.”
Ans: C
Feedback:
While high blood pressure can be causative of, or consequent to, renal failure, diabetes
is not normally a result of existing CKD. Persons with renal failure are indeed prone to
anemia, increased heart rate, decreased blood viscosity, and coagulopathies. The risk of
bleeding and thrombotic disorders can be partially mitigated by dialysis.
The nurse assessing a renal failure patient for encephalopathy caused by high uremic
levels may observe which of the following clinical manifestations?
A) Severe chest pain with pericardial friction rub on auscultation
B) Stiff immobile joints and contractures
C) Loss of recent memory and inattention
D) Pruritus with yellow hue to skin tone
Ans: C
Feedback:
Reductions in alertness and awareness are the earliest and most significant indications of
uremic encephalopathy. These often are followed by an inability to fix attention, loss of
recent memory, and perceptual errors in identifying people and objects. Answer choice
A refers to pericarditis; answer choice B refers to arthritis; answer choice D refers to
liver involvement.
