During the oliguric phase of acute kidney injury the nurse monitors the patient for Quizlet

Signs and symptoms of acute renal failure include:

A. bradycardia, with decreased respiration, low serum bicarbonate, and elevated pH.
B. lethargy, tachypnea, and elevated serum bicarbonate.
C. slowed respirations and low pH.
D. tachypnea, low pH, and low serum bicarbonate.

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Nursing Management: Acute Kidney Injury and Chronic Kidney Disease

Terms in this set [39]

a, b, c, d, e. High-risk patients include those exposed
to nephrotoxic agents and advanced age [a], massive
trauma [b], prolonged hypovolemia or hypotension
[possibly b and c], obstetric complications [c], cardiac
failure [d], preexisting chronic kidney disease, extensive burns, or sepsis. Patients with prostate cancer may have
obstruction of the outflow tract, which increases risk of
postrenal AKI [e].

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b. ECG changes
d. pulmonary edema

Rationale: The nurse monitors the patient in the oliguric phase of acute renal injury for the following:

-Hypertension and pulmonary edema: When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output [i.e., anuria, oliguria], the neck veins may become distended with a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure [HF], pulmonary edema, and pericardial and pleural effusions.

-Hyponatremia: Damaged tubules cannot conserve sodium. Consequently, the urinary excretion of sodium may increase, which results in normal or below-normal serum levels of sodium.

-Electrocardiographic changes and hyperkalemia: Initially, clinical signs of hyperkalemia are apparent on electrocardiogram [ECG] demonstrating peaked T waves, widening of the QRS complex, and ST-segment depression.

-Urinary specific gravity: Urinary specific gravity is fixed at about 1.010.

ANS:A
When the patient selects an apple, green beans, and a roast beef sandwich, the patient demonstrates understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 1/2 cup.

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Terms in this set [26]

A. hypertension.
B. electrocardiographic [ECG] changes.
D. pulmonary edema.
You monitor the patient in the oliguric phase of AKI for hypertension and pulmonary edema. When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output [anuria and oliguria], the neck veins may become distended and have a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions. The patient is monitored for hyponatremia. Damaged tubules cannot conserve sodium, and the urinary excretion of sodium may increase, resulting in normal or below-normal levels of serum sodium. Monitoring may reveal ECG changes and hyperkalemia. Initially, clinical signs of hyperkalemia are apparent on electrocardiogram, which demonstrate peaked T waves, widening of the QRS complex, and ST-segment depression. Urinary specific gravity is fixed at about 1.010.

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a
c

Which descriptions characterize AKI? Select all that apply

a. primary cause of death is infection
b. it almost always affects older people
c. disease course is potentially reversible
d. most common cause is diabetic nephropathy
e. cardiovascular disease is most common cause of death

b
d

During the oliguric phase of AKI, the nurse monitors the patient for Select all that apply

a. hypotension
b. ECG changes
c. hypernatremia
d. pulmonary edema
e. urine with high specific gravity

c

If a patient is in the diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances?

a. hyperkalemia and hyponatremia
b. hyperkalemia and hypernatremia
c. hypokalemia and hyponatremia
d. hypokalemia and hypernatremia

b

The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care?

a. Provide foods high in potassium.
b. Restrict fluids based on urine output.
c. Monitor output from peritoneal dialysis.
d. Offer high-protein snacks between meals.

d

When caring for a patient during the oliguric phase of acute kidney injury [AKI], which nursing action is appropriate?

a. Weigh patient three times weekly.
b. Increase dietary sodium and potassium.
c. Provide a low-protein, high-carbohydrate diet.
d. Restrict fluids according to previous daily loss

d

Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury [AKI]?

a. IV tobramycin
b. Incompatible blood transfusion
c. Poststreptococcal glomerulonephritis
d. Dissecting abdominal aortic aneurysm

a

The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention?

a. Monitor the patient's cardiac status.
b. Teach the patient about hand washing.
c. Obtain a serum specimen for electrolytes.
d. Increase direct observation of the patient.

a
b
e

Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury [AKI]? Select all that apply

a. Dehydration
b. Hypokalemia
c. Hypernatremia
d. BUN increases
e. Urine output increases

a

An unlicensed assistive personnel [UAP] reports to the RN that a patient with acute kidney failure had a urine output of 350 mL over the past 24 hours after receiving furosemide 40 mg IV push. The UAP asks the nurse how this can happen. What is the nurse's best response?

a. "During the oliguric phase of acute kidney failure, patients often do not respond well to either fluid challenges or diuretics."
b. "There must be some sort of error. Someone must have failed to record the urine output."
c. "A patient with acute kidney failure retains sodium and water, which counteracts the action of the furosemide."
d. "The gradual accumulation of nitrogenous waste products results in the retention of water and sodium."

a
b
d
e

The RN supervising a senior nursing student is discussing methods for preventing acute kidney injury [AKI]. Which points would the RN be sure to include in this discussion? Select all that apply

a. Encourage patients to avoid dehydration by drinking adequate fluids.
b. Instruct patients to drink extra fluids during periods of strenuous exercise.
c. Immediately report a urine output of less than 2 mL/kg/hr.
d. Record intake and output and weigh patients daily.
e. Monitor laboratory values that reflect kidney function.

c

For which patient is the nurse most concerned about the risk for developing kidney disease?

a. A 25-year-old patient who developed a urinary tract infection [UTI] during pregnancy
b. A 55-year-old patient with a history of kidney stones
c. A 63-year-old patient with type 2 diabetes
d. A 79-year-old patient with stress urinary incontinence

d

A patient with acute kidney injury [AKI] has an arterial blood pH of 7.30. The nurse will assess the patient for

a. vasodilation.
b. poor skin turgor.
c. bounding pulses.
d. rapid respirations.

c

A patient with severe heart failure develops elevated blood urea nitrogen [BUN] and creatinine levels. The nurse will plan care to meet the goal of

a. replacing fluid volume.
b. preventing hypertension.
c. maintaining cardiac output.
d. diluting nephrotoxic substances.

c

A patient who has acute glomerulonephritis is hospitalized with acute kidney injury [AKI] and hyperkalemia. Which information will the nurse obtain to evaluate the effectiveness of the prescribed calcium gluconate IV?

a. Urine output
b. Calcium level
c. Cardiac rhythm
d. Neurologic status

d

Which information will be most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury [AKI]?

a. Blood urea nitrogen [BUN] level
b. Urine output
c. Creatinine level
d. Calculated glomerular filtration rate [GFR]

a

In a patient with acute kidney injury [AKI] who requires hemodialysis, a temporary vascular access is obtained by placing a catheter in the left femoral vein. Which intervention will be included in the plan of care?

a. Place the patient on bed rest.
b. Start continuous pulse oximetry.
c. Discontinue the retention catheter.
d. Restrict the patients oral protein intake.

c

Which information about a patient who was admitted 10 days previously with acute kidney injury [AKI] caused by dehydration will be most important for the nurse to report to the health care provider?

a. The blood urea nitrogen [BUN] level is 67 mg/dL.
b. The creatinine level is 3.0 mg/dL.
c. Urine output over an 8-hour period is 2500 mL.
d. The glomerular filtration rate is