ATI Care of Patients with Acute Kidney Injury and Chronic Kidney Disease, Questions and Answers with Explanations, 100% Correct, Download to Score A

Test Bank

MULTIPLE CHOICE

1. Which client is most at risk for developing postrenal kidney failure?

a.            Client diagnosed with renal calculi

b.            Client with congestive heart failure

c.             Client taking NSAIDs for arthritis pain

d.            Client recovering from glomerulonephritis

ANS: A

Causes of postrenal kidney failure include disorders that obstruct the flow of urine, such as renal calculi. Heart failure can lead to prerenal failure, which is due to decreased blood flow to the kidneys. Both NSAIDs and glomerulonephritis can damage the kidney, leading to intrarenal failure.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1538

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. A client is admitted to the hospital with a serum creatinine level of 2 mg/dL. When taking the client’s history, which question does the nurse ask first?

a.            “Do you take any nonprescription medications?”

b.            “Does anyone in your family have kidney disease?”

c.             “Do you have yearly blood work done?”

d.            “Is your diet low in protein?”

ANS: A

Acute renal failure can be caused by certain medications considered to have a nephrotoxic effect, such as NSAIDs and acetaminophen. Asking the client whether he or she takes any nonprescription drugs can help determine which medication(s) might have contributed to the problem. A family history is important but is not as vital as assessing for nephrotoxic agents that the client may have ingested. Yearly blood work might reveal a trend in kidney function, but again would not be as important. A diet low in protein would not be an important factor to assess.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

3. A client with a decreased glomerular filtration rate asks how to prevent further damage to the kidneys. Which is the nurse’s best response?

a.            “The diuretics you are taking will prevent further damage.”

b.            “Kidney damage is inevitable as you age.”

c.             “Avoid taking NSAIDs.”

d.            “You will need to follow a high-protein diet.”

ANS: C

Kidney failure causes many problems, including decreased glomerular filtration rate. Nephrotoxins can worsen renal failure, especially in someone who already has some loss of kidney function.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1539

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

4. A client who has chronic kidney disease is being discharged from the hospital after receiving treatment for a hip fracture. Which information is most important for the nurse to provide to the client before discharge?

a.            “Increase your intake of foods with protein.”

b.            “Monitor your daily intake and output.”

c.             “Maintain bedrest until the fracture is healed.”

d.            “Take your aluminum hydroxide (Nephrox) with meals.”

ANS: D

Aluminum hydroxide lowers serum phosphate levels by binding phosphorus present in food. High blood phosphate levels cause hypocalcemia and osteodystrophy; this makes a client prone to fracture. Increasing protein may not be feasible for a client with chronic kidney disease and would not help prevent fracture. Intake and output will not be helpful for orthopedic problems. Bedrest will promote complications.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Expected Actions/Outcomes) MSC: Integrated Process: Teaching/Learning

5. Which intervention is most important for the nurse to implement in a client after kidney transplant surgery?

a.            Promote acceptance of new body image.

b.            Monitor magnesium levels daily.

c.             Place the client on protective isolation.

d.            Remove the indwelling (Foley) catheter as soon as possible.

ANS: D

Because of increased risk for infection related to immune suppressive drugs given to prevent rejection, the catheter is removed as soon as possible to avoid infection, usually 3 to 7 days after surgery. The client may need assistance with changes in body image, but this is not the priority. The client does not require protective precautions. Laboratory values will be monitored frequently in a post-transplant client, but this is not as important as preventing a complication by removing the catheter.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

6. During a hot summer day, an older adult client tells the clinic nurse, “I am not drinking or voiding that much these days.” The nurse notes a heart rate of 100 beats/min and a blood pressure of 90/60 mm Hg. Which action does the nurse take first?

a.            Give the client something to drink.

b.            Insert an intravenous catheter.

c.             Teach the client to drink 2 to 3 liters a day.

d.            Perform a bladder scan to assess urine volume.

ANS: A

Severe blood volume depletion can lead to kidney failure, even in those who have no kidney problem. The client is showing signs of mild volume depletion. The first action the nurse should take is to give the client something to drink. After that, the nurse should teach the client to avoid dehydration by drinking at least 2 to 3 L of fluid daily. The client does not need an IV at this time. Performing a bladder scan will not help prevent or reverse the client’s problem.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems)

MSC: Integrated Process: Nursing Process (Implementation)

7. A client is taking furosemide (Lasix). To detect a common adverse effect, the nurse obtains which assessment as a priority?

a.            Breath sounds

b.            Heart sounds

c.             Intake and output

d.            Nutritional patterns

ANS: C

Lasix is a diuretic that causes increased urine output. If too much urine output occurs, the client may be at risk for hypovolemia, which is a cause of prerenal kidney failure. A marked change in fluid balance seen in the intake and output measurement can help identify the client who may be at risk for hypovolemia. Heart sounds and breath sounds would be more important to assess if the client was receiving Lasix for fluid overload conditions, such as heart failure. Nutrition assessment is important to ensure that the client gets enough potassium, but dehydration is more common and needs more vigorous assessment.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)