Nokea
The patient is in a progressive care unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, the nurse should
- A. draw blood from the left arm.
- B. take blood pressures from the left arm.
- C. start a new intravenous line in the left lower arm.
- D. auscultate the left arm for a bruit and palpate for a thrill.
Correct Answer: D
Rationale: The correct answer is D. Auscultating the left arm for a bruit and palpating for a thrill post arteriovenous fistula implantation is crucial to assess the patency and functionality of the fistula. A bruit indicates turbulent blood flow, while a thrill signifies the presence of a strong pulse through the fistula. These assessments help identify any complications like stenosis or thrombosis. Drawing blood or taking blood pressures from the arm with the fistula can lead to inaccurate results or damage the fistula. Starting a new IV line in the left lower arm is unnecessary and not relevant to monitoring the arteriovenous fistula.
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The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is
- A. oliguria.
- B. azotemia.
- C. acute kidney injury.
- D. prerenal disease.
Correct Answer: B
Rationale: The correct answer is B: azotemia. Azotemia refers to elevated levels of nitrogenous waste products like BUN and creatinine in the blood. This occurs when the kidneys are not functioning properly, leading to decreased filtration and excretion of waste products. Oliguria (A) is reduced urine output, not specific to elevated BUN and creatinine levels. Acute kidney injury (C) is a broader term for sudden loss of kidney function. Prerenal disease (D) typically refers to conditions affecting blood flow to the kidneys, leading to decreased kidney function, but it does not specifically describe the increase in BUN and creatinine levels.
The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient’s urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has:
- A. acute kidney injury from a prerenal condition.
- B. acute kidney injury from postrenal obstruction.
- C. intrarenal disease, probably acute tubular necrosis.
- D. a urinary tract infection.
Correct Answer: C
Rationale: The correct answer is C: intrarenal disease, probably acute tubular necrosis. The presence of coarse, muddy brown granular casts and hematuria in the urinalysis indicates damage to the renal tubules, which is characteristic of acute tubular necrosis. This condition is a type of intrarenal disease where there is direct damage to the kidney tubules, leading to decreased urinary output and symptoms like malaise and fatigue. Prerenal and postrenal conditions do not typically present with granular casts and hematuria, making choices A and B incorrect. Urinary tract infection is also unlikely to cause the specific findings seen in this case, ruling out choice D. Therefore, choice C is the most appropriate based on the urinalysis results and clinical presentation.
Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.)
- A. Hypotension
- B. Dysrhythmias
- C. Muscle cramps
- D. Hemolysis
Correct Answer: A
Rationale: The correct answer is A: Hypotension. Hemodialysis can lead to hypotension due to rapid fluid removal, causing a drop in blood pressure. This occurs as the dialysis machine removes excess fluid, affecting plasma volume. Hypotension can result in complications like dizziness, nausea, and potential cardiac issues. Dysrhythmias (B) are less common during hemodialysis for acute kidney injury. Muscle cramps (C) may occur due to electrolyte imbalances but are not as common as hypotension. Hemolysis (D) is not a common complication of hemodialysis but can occur if there are issues with the dialysis machine or blood tubing.
The patient is admitted with acute kidney injury from a postrenal cause. Acceptable treatments for that diagnosis include: (Select all that apply.)
- A. bladder catheterization.
- B. increasing fluid volume intake.
- C. ureteral stenting.
- D. placement of nephrostomy tubes.
Correct Answer: A
Rationale: The correct answer is A. Bladder catheterization helps relieve urinary obstruction, a common postrenal cause of acute kidney injury. It allows urine to drain freely from the bladder.
- B: Increasing fluid volume intake may worsen the condition by increasing the pressure on the obstructed kidneys.
- C: Ureteral stenting is used for intrarenal causes, not postrenal causes.
- D: Placement of nephrostomy tubes bypasses the obstruction but is usually reserved for more severe cases.
A normal urine output is considered to be
- A. 80 to 125 mL/min.
- B. 180 L/day.
- C. 80 mL/min.
- D. 1 to 2 L/day.
Correct Answer: D
Rationale: The correct answer is D: 1 to 2 L/day. Normal urine output typically ranges from 1 to 2 liters per day, which is considered adequate for maintaining proper hydration and eliminating waste products. A: 80 to 125 mL/min is too low for daily output. B: 180 L/day is excessively high and unrealistic. C: 80 mL/min is also too low for daily urine output. Therefore, D is the most appropriate choice based on standard guidelines for urine excretion.