Concept Of Elimination: Acute Kidney Injury

2.

A patient presents with thirst, dry skin, and decreased urine output. What diagnosis would you suspect?

Fluid Volume Deficit
Fluid Volume Excess
Hyperkalemia
Hypocalcemia

Correct Answer

A. Fluid Volume Deficit

Explanation

Based on the symptoms presented by the patient, including thirst, dry skin, and decreased urine output, the most likely diagnosis would be Fluid Volume Deficit. Thirst is a common symptom of dehydration, which is associated with a decrease in fluid volume. Dry skin can also be a sign of dehydration, as the body lacks sufficient fluid to keep the skin moisturized. Decreased urine output is another indication of fluid volume deficit, as the body conserves water by producing less urine. Therefore, based on these symptoms, Fluid Volume Deficit is the most appropriate diagnosis.

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3.

Which is the major extracellular ion?

Sodium
Potassium
Magnesium
Phosphate

Correct Answer

A. Sodium

Explanation

Sodium is the major extracellular ion because it is the most abundant positively charged ion found outside of cells. It plays a crucial role in maintaining fluid balance, nerve function, and muscle contraction. Sodium is actively pumped out of cells and is predominantly found in the extracellular fluid, making it the major extracellular ion. Potassium, magnesium, and phosphate are also important ions in the body, but they are primarily found inside cells rather than in the extracellular fluid.

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4.

Which electrolyte is the major intracellular ion?

Sodium
Potassium
Calcium
Magnesium

Correct Answer

A. Potassium

Explanation

Potassium is the major intracellular ion because it is predominantly found inside cells, while sodium is mainly found outside cells. Potassium plays a crucial role in maintaining cell membrane potential, regulating cell volume, and controlling muscle and nerve cell function. It is important for various physiological processes, including heart rhythm, nerve impulses, and muscle contractions. Calcium and magnesium are also important electrolytes, but they are primarily found outside cells and have different roles in the body.

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1

5.

Vomiting, Diarrhea, prolonged NG suction, diurectics, kidney disease, renal, liver, and heart failure, and SIADH are causes of which electrolyte deficiency?

Hypocalcemia
Hypermagnesmia
Hyponatremia
Hypokalemia

Correct Answer

A. Hyponatremia

Explanation

The given causes such as vomiting, diarrhea, prolonged NG suction, diuretics, kidney disease, renal, liver, and heart failure, and SIADH are all associated with fluid loss or excessive water intake, leading to a dilution of sodium in the body. This condition is known as hyponatremia, which is characterized by low levels of sodium in the blood.

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6.

The student nurse understands that intrarenal causes of Acute Kidney Injury (AKI) include all of the following. Select all that apply.

Anaphylaxis
Renal Stones
Bladder Cancer
Acute Glomerulonephritis
Tubular obstruction by myoglobin
Prolonged ischemia
Nephrotoxic drugs

Correct Answer(s)

A. Acute Glomerulonephritis
A. Tubular obstruction by myoglobin
A. Prolonged ischemia
A. Nephrotoxic drugs

Explanation

Intrarenal causes of AKI include those conditions and factors that cause direct damage to the kidney tissue. Rember the fire is in the house. This conditions include nephrotoxic drugs, acute glomerulonephritis, tubular obstruction by myoglobin, and prolonged ischemia.

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7.

A home health nurse finds a 89 year old patient with a history of cardiovascular disease lying on the living room floor, stating that she had fallen 2 days ago and was not able to get help or move from the spot she fell. What conditions could cause prerenal AKI in this patient?

Anaphylaxis
Renal calculi
Hypovolemia
Nephrotoxic drugs
Decrease cardiac output

Correct Answer(s)

A. Hypovolemia
A. Decrease cardiac output

Explanation

Because the patient has been completely immobile for the past 2 days, the home health nurse would be concerned with her fluid status, as she is is probably dehydrated and hypovolemic. Decreased cardiac output is most likely because she is older and takes heart medicine. Both hypovolemia and decreased cardiac ouput contribute to low perfusion to the kidneys putting her at risk for prerenal AKI.

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8.

The nurse is taking care of a patient in the oliguric phase of AKI who has developed Metabolic Acidosis. The nurse understands this complication is a result of the impairment of which of the following?

Excretion of Acid products
Excretion of sodium
Excretion of bicarbonate
Conservation of potassium

Correct Answer

A. Excretion of Acid products

Explanation

Metabolic Acidosis occurs in AKI because the kidneys cannot synthesize Ammonia or excrete acid products of metabolism, resulting in an increased acid load.

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9.

The nurse is taking care of a patient with AKI in the oliguric phase and is monitoring the patient for complications. The nurse will notify the health care provider for which complication?

Urine output change from 400ml/day to 300ml/day in last 48 hrs.
Edema of the lower extremities and sacral area
Depressed T waves and elevated ST segment on Cardiac Strip
Marked increasing muscle weakness and severe abdominal cramping.

Correct Answer

A. Marked increasing muscle weakness and severe abdominal cramping.

Explanation

Hyperkalemia is a potentially life-threatening complication of AKI in the oliguric phase. Muscle weakness and abdominal cramping are signs of neuromuscular impairment that occurs with hyperkalemia. Additionally, hyperkalemia can lead to arrhythmias of peaked T waves, prolonged PR interval, prolonged QRS interval, and depressed ST segment. Urine output of 400ml or less is expected during the oliguric phase of AKI as well as the development of peripheral edema.

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10.

The nurse is taking care of a patient on a medical oncology unit. Lab results show a potassium level of 6.5 mEq/L. The nurse understands that the priority action is to ________.

Correct Answer
Place the patient on a cardiac monitor

Explanation
Hyperkalemia can lead to fatal dysrhythmias. The nurse understands the priority action is to monitor the cardiac rhythm while contacting the physician or calling RRT if the protocol is met.

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11.

The nurse is taking care of a 72 year old patient with a history of heart failure, recently diagnosed with acute kidney injury (AKI) as a result of nephrotoxic diuretics. Currently his labs show: Potassium 6.2 mEq/L with peaked T waves, BUN 128mg/dL, SrCreatinine 4.9mg/dL, HCO3 14mEq/L. His also somnolent and disoriented. The nurse can expect which order to be the most appropriate for this patient?

Furosemide (Lasix) 80 mg IV twice a day.
Renal Replacement Therapy
IV insulin and sodium bicarbonate
Sodium polystyrene sulfonate (Kayexalate)

Correct Answer

A. Renal Replacement Therapy

Explanation

Common indicators for renal replacement therapy include high potassium levels, metabolic acidosis, change mental status, volume overload resulting in compromised cardiac status, BUN greater than 120 mg/dL, and pericarditis, pericardial effusion or cardiac tamponade. Although the other treatments may be used this will not be as effective for this older patient. Loop Diuretics may help but will not be sufficient. Insulin and sodium bicarbonate can be used temporarily to drive potassium back into the cells. Kayexlate is used to acutally decrease overall potassium in body.

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12.

Which of the following is not a function of water?

Transportation of nutrients, electrolytes, and oxygen to the cells
Excretion of waste products
Regulation of body temp
Cell macrophaging

Correct Answer

A. Cell macrophaging