Exam 1

Which intervention will be included in the plan of care for a patient with acute kidney injury (AKI) who has a temporary vascular access catheter in the left femoral vein?

• Restrict the patient’s oral protein intake.

• Restrict physical activity to bed rest.

• Discontinue the urethral retention catheter.

• Start continuous pulse oximetry.

Answer explanation

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.

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Exam 1

A 25-yr-old male patient has been admitted with a severe crushing injury after an industrial accident. Which laboratory result will be most important to report to the health care provider?

• Serum potassium level of 6.5 mEq/L

• White blood cell count of 11,500/µL

• Serum creatinine level of 2.1 mg/dL

• Blood urea nitrogen (BUN) of 56 mg/dL

Answer explanation

The hyperkalemia associated with crushing injuries may cause cardiac arrest and should be treated immediately. The nurse also will report the other laboratory values, but abnormalities in these are not immediately life threatening.

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Exam 1

A 72-yr-old patient with a history of benign prostatic hyperplasia (BPH) is admitted with acute urinary retention and elevated blood urea nitrogen (BUN) and creatinine levels. Which prescribed therapy should the nurse implement first?

• Infuse normal saline at 50 mL/hour.

• Insert urethral catheter.

• Obtain renal ultrasound.

• Draw a complete blood count.

Answer explanation

The patient’s elevation in BUN is most likely associated with hydronephrosis caused by the acute urinary retention, so the insertion of a retention catheter is the first action to prevent ongoing postrenal failure for this patient. The other actions also are appropriate but should be implemented after the retention catheter.

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Exam 1

A 62-yr-old female patient has been hospitalized for 4 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?

• The creatinine level is 3.0 mg/dL

• Urine output over an 8-hour period is 2500 mL.

• The glomerular filtration rate is less than 30 mL/min/1.73 m2.

• The blood urea nitrogen (BUN) level is 67 mg/dL.

Answer explanation

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.

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Exam 1

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?

• Notify the patient’s health care provider.

• Review the chart for the patient’s current creatinine level

• Document the QRS interval measurement.

• Check the medical record for the most recent potassium level.

Answer explanation

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.

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Exam 1

A 42-yr-old patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?

• Place the patient on a cardiac monitor.

• Insert a urinary retention catheter.

• Administer epoetin alfa (Epogen, Procrit).

• Give sodium polystyrene sulfonate (Kayexalate).

Answer explanation

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.

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Exam 1

A patient has arrived for a scheduled hemodialysis session. Which nursing action is most appropriate for the registered nurse (RN) to delegate to a dialysis technician?

• Teach the patient about fluid restrictions.

• Determine the ultrafiltration rate for the hemodialysis.

• Assess for causes of an increase in predialysis weight.

• Check blood pressure before starting dialysis.

Answer explanation

Dialysis technicians are educated in monitoring for blood pressure. Assessment, adjustment of the appropriate ultrafiltration rate, and patient teaching require the education and scope of practice of an RN.

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Exam 1

A licensed practical/vocational nurse (LPN/LVN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?

• The LPN/LVN administers the iron supplement and phosphate binder with lunch.

• The LPN/LVN administers the erythropoietin subcutaneously.

• The LPN/LVN assists the patient to ambulate out in the hallway.

• The LPN/LVN carries a tray containing low-protein foods into the patient’s room

Answer explanation

Oral phosphate binders should not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder should be given with a meal and the iron given at a different time. The other actions by the LPN/LVN are appropriate for a patient with renal insufficiency

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Exam 1

A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information should the nurse report promptly to the health care provider?

• The patient’s peritoneal effluent appears cloudy.

• The patient’s abdomen appears bloated after the inflow.

• The patient has an outflow volume of 1800 mL.

• The patient has abdominal pain during the inflow phase

Answer explanation

Cloudy-appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.

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Exam 1

The nurse is assessing a patient 4 hours after a kidney transplant. Which information is most important to communicate to the health care provider?

• he blood urea nitrogen (BUN) and creatinine levels are elevated.

• The patient’s central venous pressure (CVP) is decreased.

• The patient has a level 7 (0- to 10-point scale) incisional pain.

• The urine output is 900 to 1100 mL/hr.

Answer explanation

The decrease in CVP suggests hypovolemia, which must be rapidly corrected to prevent renal hypoperfusion and acute tubular necrosis. The other information is not unusual in a patient after a transplant.

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Exam 1