John Matthews

A 64-year-old male with:

• HTN, diabetes

• Recent illness + poor intake

• Taking ACE inhibitor + NSAIDs

Findings:

• Urine output: 250 mL/day

• Edema

• SOB

• Weight gain

Labs:

• BUN 48 ↑

• Creatinine 3.1 ↑

• Potassium 5.8 ↑

What is the diagnosis?

Acute Kidney Injury (AKI)
Likely prerenal → progressing to intrinsic

What caused his AKI?

Dehydration + NSAIDs + ACE inhibitors
→ ↓ kidney perfusion
→ nephrotoxicity

Why is potassium elevated?

• Kidneys cannot excrete potassium → hyperkalemia

What is the MOST life-threatening complication?

Hyperkalemia → cardiac dysrhythmias

What is the priority nursing action?

• Cardiac monitoring

• Treat potassium:

  • Calcium gluconate

  • insulin + glucose

  • Kayexalate

Why does he have edema and SOB?

Fluid retention → volume overload → pulmonary edema

A nurse is assessing a client with suspected poststreptococcal glomerulonephritis. Which finding is MOST specific?

A. +4 protein in urine
B. RBC casts in urine
C. Frothy urine
D. Low albumin

B. RBC casts in urine

• hallmark of glomerular inflammation

• others = nephrotic features

Which assessment finding indicates nephrotic syndrome?

A. Tea-colored urine
B. RBC casts
C. Frothy urine with +4 protein
D. Elevated creatinine

C. Frothy urine with +4 protein

• classic nephrotic

• tea-colored + RBC = nephritic

A nurse is caring for a patient with AKI and potassium 5.8. What is priority?

A. Give diuretics
B. Monitor intake/output
C. Initiate cardiac monitoring
D. Restrict sodium

C. Initiate cardiac monitoring

• hyperkalemia = deadly arrhythmias FIRST priority

Which findings indicate fluid volume excess? Select all.

A. Weight gain
B. Edema
C. Decreased urine output
D. Hypotension
E. Hypertension

A, B, C, E

• hypotension = incorrect (usually HTN)

Why is albumin low in nephrotic syndrome?

A. Decreased production
B. Increased breakdown
C. Loss through kidneys
D. Dilution from fluids

C. Loss through kidneys

• damaged glomeruli leak protein

Which intervention is MOST important for nephrotic syndrome?

A. Encourage fluids
B. High sodium diet
C. Daily weights
D. Limit protein

C. Daily weights

• best indicator of fluid status

A patient with glomerulonephritis develops severe headache and blurred vision. What should the nurse suspect?

A. Hypoglycemia
B. Stroke
C. Hypertensive emergency
D. Infection

C. Hypertensive emergency

• common complication of GN

A 64-year-old with HTN and diabetes presents with decreased urine output, edema, and elevated BUN/creatinine. What is the diagnosis?

A. Chronic kidney disease
B. Acute kidney injury
C. Nephrotic syndrome
D. Glomerulonephritis

B. Acute kidney injury

• Sudden decline in kidney function + oliguria + ↑ labs

Which lab value is MOST concerning?

A. BUN 48
B. Creatinine 3.1
C. Potassium 5.8
D. Sodium normal

C. Potassium 5.8

• Hyperkalemia → life-threatening arrhythmias

What is the PRIORITY nursing action?

A. Administer fluids
B. Monitor weight
C. Place on cardiac monitor
D. Encourage ambulation

C. Place on cardiac monitor

• Hyperkalemia = immediate cardiac risk

Which factors contributed to this patient’s AKI? Select all.

A. NSAID use
B. ACE inhibitor use
C. Dehydration
D. Infection
E. High protein diet

A, B, C

• NSAIDs + ACE inhibitors + dehydration → ↓ kidney perfusion

Why does this patient have edema and shortness of breath?

A. Dehydration
B. Fluid overload
C. Infection
D. Low potassium

B. Fluid overload

• Kidneys not excreting fluid → pulmonary + peripheral edema

Which intervention helps LOWER potassium levels?

A. Sodium bicarbonate
B. Calcium gluconate
C. Insulin with glucose
D. Normal saline

C. Insulin with glucose

• Drives potassium INTO cells (temporary fix)

• Calcium protects heart but doesn’t lower K

Which finding indicates worsening kidney function?

A. Increased urine output
B. Decreased creatinine
C. Rising BUN and creatinine
D. Stable weight

C. Rising BUN and creatinine

• Indicates declining renal filtration