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WorksheetsAcute Kidney Injury and Diabetes Nursing Questions
Total questions: 87
Worksheet time: 44mins
A 68-year-old patient is admitted with suspected acute kidney injury. The nurse reviews the following laboratory results: BUN 85 mg/dL, Creatinine 1.2 mg/dL, and urine output of 250 mL in the past 24 hours. The patient reports severe dehydration for the past week. What is the most likely cause of the elevated BUN with normal creatinine?
Intrarenal acute kidney injury from nephrotoxic medications
Prerenal azotemia from dehydration and increased protein breakdown
Postrenal obstruction from enlarged prostate
Chronic kidney disease progression
A patient in the oliguric phase of acute kidney injury develops hyperkalemia. Which interventions should the nurse anticipate?
Administer insulin with dextrose to shift potassium intracellularly
Give IV calcium gluconate to stabilize cardiac membranes
Prepare for immediate hemodialysis
Administer sodium polystyrene sulfonate (Kayexalate)
Administer sodium bicarbonate for metabolic acidosis
A patient with Type 1 diabetes is scheduled for major surgery tomorrow morning. The patient normally takes 30 units of long-acting insulin at bedtime. What is the most appropriate perioperative insulin management?
Continue the full 30 units of long-acting insulin as scheduled
Hold all insulin since the patient will be NPO
Reduce the daily insulin dose on the morning of surgery
Switch to sliding scale short-acting insulin only
A nurse is caring for a patient in the diuresis phase of acute kidney injury. The patient's urine output has increased to 3,000 mL in 24 hours. What is the priority nursing assessment?
Monitor for signs of fluid overload and pulmonary edema
Assess for electrolyte depletion, particularly hypokalemia
Check for signs of uremic encephalopathy
Evaluate for hyperphosphatemia and hypocalcemia
A patient with acute kidney injury develops metabolic acidosis. The nurse observes rapid, deep breathing patterns. This compensatory mechanism is called:
Cheyne-Stokes respirations
Biot's respirations
Kussmaul respirations
Apneustic breathing
A diabetic patient presents with complaints of severe hip and thigh pain, muscle weakness, and difficulty standing from a sitting position. These symptoms are most consistent with:
Peripheral neuropathy (distal symmetric)
Autonomic neuropathy
Proximal neuropathy (diabetic amyotrophy)
Mononeuropathy (focal neuropathy)
A hospitalized diabetic patient has been NPO for 12 hours due to bowel obstruction. Despite not eating, the patient's blood glucose is 280 mg/dL. What is the most likely explanation?
The patient secretly consumed food or beverages
Laboratory error in blood glucose measurement
Stress and illness can cause hyperglycemia even when NPO
Previous oral antidiabetic medications are still active
A patient with acute kidney injury is prescribed aluminum hydroxide. What is the primary purpose of this medication?
Reduce gastric acid production to prevent ulcers
Bind phosphate in the gastrointestinal tract
Increase calcium absorption from the intestines
Neutralize metabolic acidosis
A nurse is assessing a patient with suspected diabetic retinopathy. Which interventions should be included in the care plan?
Maintain tight blood sugar control
Recommend yearly retinal examinations
Encourage smoking cessation
Control hypertension
Consider laser treatment if indicated
A patient with acute kidney injury develops uremic encephalopathy. Which assessment finding would the nurse most likely observe?
Hyperactive reflexes and muscle spasms
Confusion, seizures, and altered mental status
Severe hypertension and bradycardia
Increased urine output and polyuria
A diabetic patient calls the clinic reporting flu-like symptoms for 3 days. Blood glucose readings have been 300-400 mg/dL despite taking usual medications. What is the most important instruction for this Type 1 diabetic patient?
Stop taking insulin until able to eat normally
Check urine ketones to assess for diabetic ketoacidosis
Increase carbohydrate intake to prevent hypoglycemia
Wait 24 hours before seeking medical attention
A patient with chronic kidney disease secondary to diabetic nephropathy requires dietary modifications. Which dietary restrictions should the nurse teach?
Limit sodium intake to reduce fluid retention
Restrict potassium to prevent hyperkalemia
Increase protein intake to maintain muscle mass
Limit phosphorus to prevent bone
A patient in acute kidney injury develops hypocalcemia with positive Chvostek's and Trousseau's signs. What is the most appropriate immediate intervention?
Administer oral calcium carbonate supplements
Give IV calcium gluconate or calcium chloride
Increase dietary calcium through milk products
Administer vitamin D supplements
A diabetic patient with gastroparesis is experiencing inconsistent glucose absorption. Which type of diabetic neuropathy is responsible for this complication?
Peripheral neuropathy affecting the extremities
Autonomic neuropathy affecting the gastrointestinal system
Proximal neuropathy affecting the hip muscles
Mononeuropathy affecting cranial nerves
A patient presents with metabolic syndrome. Which criteria would confirm this diagnosis?
Blood pressure ≥130/85 mmHg
Waist circumference >40 inches in men or >35 inches in women
Triglycerides ≥150 mg/dL
Fasting glucose ≥100 mg/dL
HDL cholesterol <40 mg/dL in men, <50 mg/dL in women
A patient with acute kidney injury is receiving epoetin alfa (Procrit). What is the primary indication for this medication?
Stimulate white blood cell production to prevent infection
Increase red blood cell production to treat anemia
Enhance platelet function to prevent bleeding
Improve kidney function and glomerular filtration rate
A nurse is caring for a diabetic patient who reports not feeling typical hypoglycemic symptoms. Blood glucose is 45 mg/dL, but the patient denies sweating, shakiness, or hunger. This condition is most likely related to:
Peripheral neuropathy affecting pain sensation
Autonomic neuropathy causing hypoglycemic unawareness
Proximal neuropathy affecting muscle function
Retinopathy affecting visual symptoms
A patient with acute kidney injury is in the onset phase. Which interventions are most appropriate during this phase?
Aggressive diuretic therapy
Blood pressure monitoring
Assessment for underlying causes
Daily weight measurements
Strict intake and output monitoring
A diabetic patient presents with double vision, eye pain, and facial paralysis on one side. These symptoms are most consistent with:
Diabetic retinopathy with macular edema
Autonomic neuropathy affecting cardiac function
Mononeuropathy affecting cranial nerves
Peripheral neuropathy with sensory loss
A patient with acute kidney injury develops severe hyperkalemia with ECG changes. The physician orders IV calcium gluconate. What is the primary purpose of this intervention?
Lower serum potassium levels
Stabilize cardiac cell membranes
Increase calcium levels to normal
Improve kidney function
A nurse is teaching foot care to a diabetic patient with peripheral neuropathy. Which instructions should be included?
Trim toenails in a curved fashion following nail shape
File toenail edges after cutting straight across
Wear shoes at all times, even indoors
Wash feet with lukewarm water and mild soap
Inspect feet daily using a mirror for hard-to-see areas
A patient with diabetic nephropathy has albumin in the urine and elevated BUN and creatinine levels. The patient also reports decreased insulin breakdown. What percentage of diabetic patients develop end-stage kidney disease requiring dialysis or transplant?
10%
25%
50%
75%
A patient with acute kidney injury is experiencing uremia. Which manifestations should the nurse assess for?
Uremic frost on the skin in severe cases
Encephalopathy with confusion and seizures
Immunosuppression increasing infection risk
Gastrointestinal symptoms including nausea and vomiting
Bleeding disorders due to platelet dysfunction
Assess for electrolyte depletion, particularly hypokalemia
Fluid overload is concern in oliguria phase
Assess for electrolyte depletion, particularly hypokalemia
Uremic symptoms improve in diuresis phase
These are oliguria phase concerns
Peripheral neuropathy causes numbness, burning, tingling, and decreased sensation
Peripheral neuropathy causes numbness, burning, tingling, and decreased sensation
Pain sensation is decreased, not increased
Gait becomes unsteady due to decreased sensation
Kussmaul respirations
Different breathing patterns not related to acidosis compensation
Different breathing patterns not related to acidosis compensation
Kussmaul respirations
Proximal neuropathy (diabetic amyotrophy)
Peripheral neuropathy affects distal extremities
Autonomic affects organ systems
Proximal neuropathy (diabetic amyotrophy)
Mononeuropathy affects single nerves
Kidneys remain vulnerable, avoid nephrotoxins, follow-up needed, BP monitoring important
Kidneys remain vulnerable, avoid nephrotoxins, follow-up needed, BP monitoring important
Contrast dye should be avoided
Some dietary restrictions may continue
Stress and illness can cause hyperglycemia even when NPO
Less likely explanations given the clinical scenario
Less likely explanations given the clinical scenario
Stress and illness can cause hyperglycemia even when NPO
Less likely explanations given the clinical scenario
Bind phosphate in the gastrointestinal tract
Not the primary indication in AKI
Bind phosphate in the gastrointestinal tract
Not the primary indication in AKI
Not the primary indication in AKI
Question 11:
A
B
C
D
F
Which of the following is a typical symptom of uremic encephalopathy?
Physical activity should be maintained appropriately
Confusion, seizures, and altered mental status
Not typical of uremic encephalopathy
Not typical of uremic encephalopathy
What is the appropriate initial response for a type 1 diabetic with illness and high glucose?
Never stop insulin in Type 1
Check urine ketones to assess for diabetic ketoacidosis
Not appropriate initial responses
Not appropriate initial responses
Which of the following are required in chronic kidney disease (CKD) management? (Select all that apply)
Carbohydrates for energy
Sodium restriction
Potassium restriction
Protein should be limited to reduce urea
Phosphorus restriction
What is the immediate treatment for symptomatic hypocalcemia?
Too slow for immediate intervention
Give IV calcium gluconate or calcium chloride
Too slow for immediate intervention
Too slow for immediate intervention
Which type of neuropathy results in gastroparesis?
Other types don't affect GI motility
Autonomic neuropathy affecting the gastrointestinal system
Other types don't affect GI motility
Other types don't affect GI motility
Which of the following are criteria for metabolic syndrome?
HDL
Triglycerides
Waist circumference
BP
Glucose
What is the mechanism of action of epoetin alfa in treating anemia?
Not the mechanism of epoetin alfa
Increase red blood cell production to treat anemia
Not the mechanism of epoetin alfa
Not the mechanism of epoetin alfa
What is the cause of hypoglycemic unawareness in autonomic neuropathy?
Not the cause
Autonomic neuropathy causing hypoglycemic unawareness
Not the cause
Not the cause
Which of the following are appropriate interventions during the onset phase of acute kidney injury?
Monitor and assess for causes
Monitor for changes in condition
Monitor blood pressure management
Monitor for complications
Administer aggressive diuretics
Which of the following is indicated by double vision, eye pain, and facial paralysis in a diabetic patient?
Diabetic retinopathy
Diabetic neuropathy
Mononeuropathy affecting cranial nerves
Diabetic nephropathy
What is the primary purpose of administering calcium gluconate to a patient with hyperkalemia?
Lower potassium levels
Stabilize cardiac cell membranes
Improve kidney function
Lower calcium levels
Which of the following are appropriate foot care instructions for diabetic patients?
File edges after straight cutting
Always wear shoes
Use lukewarm water
Inspect feet daily
Trim nails curved
According to the document, what percentage of diabetics may need dialysis or transplant?
10%
25%
50%
75%
Which of the following are symptoms or complications of uremia?
Uremic frost
Encephalopathy
GI symptoms
Immunosuppression
Bleeding disorders
A diabetic patient is admitted with coronary artery disease. The nurse recognizes this as a macrovascular complication. What is the primary pathophysiological mechanism causing this complication?
Capillary basement membrane thickening
Atherosclerosis leading to arterial narrowing
Glomerular damage from hyperglycemia
Nerve ischemia and metabolic toxicity
A patient with Type 2 diabetes receiving total parenteral nutrition (TPN) develops hyperglycemia. What is the most appropriate nursing intervention?
Discontinue the TPN feeding immediately
Monitor blood glucose and provide insulin coverage without stopping feedings
Reduce the TPN rate by 50% until glucose normalizes
Switch to enteral feeding to better control glucose
A patient in the recovery phase of acute kidney injury asks when they can resume taking ibuprofen for arthritis pain. What is the nurse's best response?
You can resume ibuprofen immediately since your kidneys are recovering.
Wait until your creatinine returns to normal, then ibuprofen is safe.
Your kidneys remain vulnerable for up to 1 year, so avoid NSAIDs during this time.
You can take half the normal dose of ibuprofen starting next week.
A nurse is teaching a diabetic patient about sick day management. Which instructions should be included?
Test blood glucose every 4 hours during illness
Weigh yourself daily and report unexpected weight loss
Drink 4-6 ounces of water every half hour
Continue taking insulin and diabetes medications as usual
Stop all medications if unable to eat solid foods
A patient with acute kidney injury develops left ventricular hypertrophy secondary to fluid overload and hypertension. This change in cardiac structure primarily results in:
Increased cardiac output and improved circulation
Enhanced ventricular filling and stroke volume
Reduced chamber filling capacity and diastolic dysfunction
Improved coronary artery perfusion
A diabetic patient calls the clinic reporting moderate to high ketone levels in urine, vomiting for 8 hours, and blood glucose of 350 mg/dL. What is the most appropriate nursing advice?
Increase fluid intake and recheck ketones in 4 hours
Take extra short-acting insulin and monitor closely at home
Continue current medications and call back if symptoms worsen
Seek immediate medical attention at the emergency department
A patient with acute kidney injury is receiving dobutamine (Dobutrex) in the ICU. Which effects should the nurse monitor for? (Select all that apply)
Increased heart rate
Decreased blood pressure
Increased urine output
Arrhythmias
Hyperkalemia
A nurse is assessing a patient with diabetic autonomic neuropathy. Which finding would be most characteristic of cardiac autonomic neuropathy?
Severe peripheral edema and jugular vein distention
Chest pain radiating to the left arm during activity
Tachycardia and orthostatic hypotension
Irregular heart rhythm with premature contractions
A patient with diabetes mellitus has "apple-shaped" fat distribution around the abdomen. This body habitus is most associated with increased risk for:
Peripheral neuropathy and foot ulcers
Diabetic retinopathy and vision loss
Metabolic syndrome and cardiovascular disease
Diabetic nephropathy and kidney failure
A diabetic patient presents with urinary retention, neurogenic bladder requiring catheterization, and frequent urinary tract infections. These symptoms are most consistent with:
Peripheral neuropathy affecting sensory nerves
Autonomic neuropathy affecting renal function
Proximal neuropathy affecting pelvic muscles
Mononeuropathy affecting pudendal nerves
A patient with acute kidney injury develops severe metabolic acidosis that is refractory to sodium bicarbonate therapy. What intervention should the nurse anticipate?
Increase the sodium bicarbonate dosage
Add potassium supplements to correct hypokalemia
Prepare the patient for emergency dialysis
Administer calcium gluconate for hypocalcemia
A patient with diabetic retinopathy develops neovascular glaucoma. The nurse understands this complication occurs when:
Fluid leaks into the macula causing blurred vision
Abnormal blood vessels block fluid drainage, increasing eye pressure
Scarring pulls the retina away from the back of the eye
Cataracts develop from prolonged hyperglycemia
A patient with acute kidney injury receives sorbitol along with sodium polystyrene sulfonate (Kayexalate). What is the purpose of adding sorbitol?
To prevent constipation
To promote excretion of potassium
To induce diarrhea
To enhance the effect of Kayexalate
A diabetic patient with peripheral vascular disease develops a foot ulcer. What percentage of lower limb amputations occur in diabetic patients?
25-40%
40-50%
50-75%
75-90%
A nurse is teaching an elderly diabetic patient about barriers to diabetes self-management. Which factors should be addressed in the teaching plan?
Limited financial resources for supplies
Decreased mobility limiting exercise options
Depression and social isolation
Memory deficits affecting medication compliance
Hearing and vision impairments
A patient with acute kidney injury develops anuria (urine output <100 mL/day). This finding is most characteristic of which phase of AKI?
Onset phase when injury first occurs
Oliguria phase with severe reduction in urine output
Diuresis phase when kidneys begin recovering
Recovery phase when function normalizes
A patient with diabetes develops stroke as a macrovascular complication. Which pathophysiological factors contribute to increased stroke risk?
Chronic hyperglycemia damaging blood vessel linings
Atherosclerotic stiffening and narrowing of arteries
Capillary basement membrane thickening
Increased coagulation risk from vascular inflammation
Two times higher stroke risk compared to non-diabetics
A patient with diabetic nephropathy asks about preventing progression to end-stage renal disease. What is the most important intervention the nurse should emphasize?
Tight glycemic and blood pressure control
Regular exercise
Low-protein diet
Increased fluid intake
Which of the following is the mechanism of action of Sevelamer (Renagel)?
A) Binding dietary phosphate in the gastrointestinal tract
B) Doesn't affect calcium absorption
C) Doesn't stimulate erythropoietin
D) Doesn't affect sodium excretion
Which of the following is a macrovascular complication of diabetes?
Microvascular complications
Atherosclerosis leading to arterial narrowing
Nephropathy (microvascular)
Neuropathy
What is the appropriate nursing action for a patient receiving TPN (total parenteral nutrition) who is also diabetic?
Stop TPN immediately
Monitor blood glucose and provide insulin coverage without stopping feedings
Reduce insulin dose
Increase carbohydrate intake
Which of the following are true regarding diabetic nephropathy?
Incorrect: May not be appropriate for patient condition
Incorrect: Don't stop TPN abruptly
Incorrect: Don't reduce rate, adjust insulin
Correct
Correct
Your kidneys remain vulnerable for up to 1 year, so avoid NSAIDs during this time.
Incorrect
Incorrect
Correct
Incorrect
Which of the following are appropriate actions for a diabetic patient during illness?
Correct
Correct
Correct
Correct
Correct
Reduced chamber filling capacity and diastolic dysfunction is caused by:
Incorrect: Hypertrophy impairs rather than improves function
Incorrect: Hypertrophy impairs rather than improves function
Correct
What should you do if you have high ketones, vomiting >6 hours, and high glucose?
Incorrect: This is a medical emergency requiring immediate intervention
Incorrect: This is a medical emergency requiring immediate intervention
Incorrect: This is a medical emergency requiring immediate intervention
Correct: Seek immediate medical attention at the emergency department
Which of the following are true regarding dobutamine?
Correct
Correct
Correct
Correct
Incorrect: Usually increases heart rate
Cardiac autonomic neuropathy causes which of the following?
Incorrect: Not specific to autonomic neuropathy
Incorrect: Not specific to autonomic neuropathy
Correct: Tachycardia and orthostatic hypotension
Metabolic syndrome and cardiovascular disease are associated with which of the following?
Incorrect
Incorrect
Correct
Which of the following are primary effects of calcium channel blockers in acute kidney injury (AKI)?
Increase urine output
Reduce proteinuria
Protect kidney cells
Improve GFR
Lower potassium
Which of the following is most likely to affect renal function in a patient with diabetes?
Peripheral neuropathy
Autonomic neuropathy affecting renal function
Sensory neuropathy
Motor neuropathy
What is the most appropriate intervention for a patient with refractory acidosis?
Administer sodium bicarbonate
Increase IV fluids
Prepare the patient for emergency dialysis
Restrict protein intake
Which of the following are preferred in hospital management of diabetes?
Provide appropriate diet
Monitor glucose
Treat hypoglycemia
Protocols
Insulin
What is the mechanism of neovascular glaucoma?
Macular edema
Abnormal blood vessels block fluid drainage, increasing eye pressure
Retinal detachment
Cataracts
Which of the following are important considerations when prescribing steroids to diabetic patients?
Patient education
Insulin adjustment
Discontinue diabetic medications
Increased monitoring
DKA watch
What is the primary purpose of sorbitol when given with Kayexalate?
Lower blood glucose
Prevent constipation and accelerate potassium excretion
Treat hypernatremia
Reduce proteinuria
What percentage of body weight is water in an average adult?
25-35%
35-50%
50-75%
75-90%
Which of the following are barriers mentioned in the document for elderly diabetic patients?
[Option B]
[Option A]
[Option C]
[Option E]
[Option D]
Oliguria phase with severe reduction in urine output
[Option A]
Oliguria phase with severe reduction in urine output
[Option C]
[Option D]
Which of the following are effects of hyperglycemia on blood vessels?
Option A
Option B
Option C
Option E
Option F
What is the primary prevention strategy for diabetic nephropathy progression?
[Option A]
[Option B]
Controlling blood pressure and blood glucose levels
[Option D]
Uremic frost presents as:
[Option A]
[Option D]
[Option E]
[Option B]
Fruity breath
