Medical-Surgical Nursing, Renal & Gu · Aki Vs Ckd

Free preview · Original latest version

Sample questions from Medical-Surgical Nursing, Renal & Gu · Aki Vs Ckd

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 72-year-old client in the emergency department has had vomiting and diarrhea for 3 days. Blood pressure is 88/54 mm Hg, heart rate is 118/min, mucous membranes are dry, urine output is 15 mL/hr, and serum creatinine is 2.1 mg/dL compared with a baseline of 0.9 mg/dL. Which action should the nurse anticipate first?

   • A.Administer an isotonic IV fluid bolus as prescribed
   • B.Restrict oral and IV fluids
   • C.Prepare the client for immediate hemodialysis
   • D.Administer a potassium supplement

   Rationale: The findings suggest prerenal AKI from volume depletion, so restoring circulating volume with isotonic fluid is the priority. Fluid restriction could worsen renal perfusion, and dialysis is not indicated solely by this creatinine level. Potassium should not be supplemented without a level and may be elevated in AKI; the exam takeaway is to correct a reversible perfusion problem promptly.

2. 2.A 64-year-old client in the ICU develops oliguria 2 days after septic shock. Blood pressure is now 112/68 mm Hg, urine output is 10 mL/hr, creatinine has risen from 1.0 to 3.4 mg/dL, and urinalysis shows muddy brown casts. Which explanation best describes the kidney injury?

   • A.Prerenal injury from ongoing fluid loss
   • B.Intrinsic tubular injury from ischemia
   • C.Postrenal injury from ureteral obstruction
   • D.Chronic kidney disease from long-term nephron loss

   Rationale: Muddy brown casts after shock strongly support acute tubular injury, an intrinsic form of AKI caused by ischemia. Ongoing prerenal injury is less likely with restored blood pressure and this urine sediment. Obstruction does not explain the casts, and CKD is a chronic process rather than a sudden deterioration; the takeaway is to connect sediment and clinical context.

3. 3.A 58-year-old client on a medical unit has AKI and has produced no urine for 8 hours. The client reports suprapubic pressure; the bladder is palpable, and a bedside bladder scan estimates 780 mL. What should the nurse do first?

   • A.Encourage oral fluids and reassess in 2 hours
   • B.Notify the provider and anticipate urinary catheterization
   • C.Administer a prescribed loop diuretic
   • D.Document the finding as expected in AKI

   Rationale: A distended bladder with a large residual suggests postrenal obstruction that requires prompt relief and evaluation. Fluids do not resolve an outlet obstruction and may increase discomfort. A diuretic will not correct the blockage, and documenting without intervention delays treatment; the exam takeaway is to assess for reversible obstruction in oliguria.

4. 4.A 70-year-old client with AKI has a potassium level of 6.7 mEq/L and peaked T waves on the ECG. Blood pressure is 146/82 mm Hg and the client is alert. Which prescribed intervention should the nurse implement first?

   • A.Administer IV calcium gluconate
   • B.Administer oral sodium polystyrene sulfonate
   • C.Provide a low-potassium meal
   • D.Repeat the potassium level in 4 hours

   Answer and rationale are in the full material.

5. 5.A 67-year-old client with AKI has potassium 6.2 mEq/L, glucose 104 mg/dL, and no ECG changes. The provider prescribes regular insulin IV with dextrose. Which nursing action is most important after administration?

   • A.Monitor blood glucose closely
   • B.Encourage foods high in potassium
   • C.Restrict all carbohydrate intake for 24 hours
   • D.Hold the next creatinine measurement

   Answer and rationale are in the full material.