NUR 303 Exam 3: Renal (AKI, CKD, and Dialysis)

NCLEX-style review flashcards covering acute kidney injury (AKI), chronic kidney disease (CKD), hemodialysis, and peritoneal dialysis based on the NUR 303 Exam 3 practice module.

In a $70\,\text{kg}$ patient with a urine output of $25\,\text{mL/hour}$ for $6\,\text{hours}$ and serum creatinine rising from $0.8$ to $1.2\,\text{mg/dL}$ in $36\,\text{hours}$, why is prompt assessment for acute kidney injury (AKI) warranted?

The patient's creatinine rose by at least $0.3\,\text{mg/dL}$ within $48\,\text{hours}$, and urine output remained below $0.5\,\text{mL/kg/hour}$ ($< 35\,\text{mL/hour}$) for $6\,\text{hours}$; a normal-appearing absolute creatinine value does not exclude acute injury.

What pathophysiological progression explains why a patient with prolonged hemorrhagic shock remains oliguric with rising creatinine and granular casts after circulation is restored?

Sustained prerenal hypoperfusion has progressed to intrinsic ischemic tubular injury.

What is the priority nursing action for a patient with AKI, heart failure, bilateral crackles, leg edema, and an oxygen saturation of $88\%$ who produces $15\,\text{mL/hour}$ of urine?

Support oxygenation and urgently escalate the fluid-overload findings, as crackles and hypoxemia indicate pulmonary edema and extra fluids would worsen respiratory failure.

A postoperative patient's Foley catheter output drops to $5\,\text{mL/hour}$, and the nurse observes a palpable full bladder with drainage tubing compressed under the thigh. What is the nurse's first action?

Relieve the tubing compression and reassess catheter drainage and bladder discomfort.

A patient receiving gentamicin has a serum creatinine rise from $1.0$ to $1.9\,\text{mg/dL}$ and declining urine output. What is the nurse's best action before giving the next scheduled dose?

Contact the prescriber or pharmacist before administering the dose for a renal function and drug-level review.

What is the therapeutic purpose of administering intravenous calcium to a patient with AKI presenting with hyperkalemia ($\text{potassium } 6.4\,\text{mEq/L}$) and QRS widening?

It stabilizes cardiac membranes and reduces myocardial excitability while other interventions work to lower serum potassium.

Why must scheduled glucose monitoring continue after administering IV regular insulin and dextrose for severe hyperkalemia in an anuric dialysis patient?

To detect delayed hypoglycemia, which can occur due to impaired renal clearance of insulin.

Which intervention directly removes potassium from the body when hyperkalemia ($\text{potassium } 6.8\,\text{mEq/L}$) rebounds in an anuric CKD patient?

Hemodialysis arranged urgently by the nephrology team.

A prescribed AKI fluid plan adds yesterday's measured losses to $600\,\text{mL}$. If yesterday's urine output was $350\,\text{mL}$ and nasogastric drainage was $200\,\text{mL}$, what is today's total fluid allowance?

$1150\,\text{mL}$ (calculated as measured losses of $350\,\text{mL} + 200\,\text{mL} = 550\,\text{mL}$, plus $600\,\text{mL}$).

What mechanism explains why a patient in the AKI recovery phase with urine output of $4\,\text{L/day}$ develops weight loss, dizziness, and a potassium level of $3.1\,\text{mEq/L}$ while creatinine remains elevated?

Tubular concentrating ability has not recovered fully, leading to large fluid and electrolyte losses before solute clearance normalizes.

Which clinical trend best supports improving renal function rather than simply an increase in urine volume?

Serum creatinine falling toward baseline while systemic perfusion and urine output remain adequate.

Why does an eGFR of $48\,\text{mL/min/1.73 m}^2$ on a single test during a dehydrating illness fail to confirm stage 3 chronic kidney disease (CKD)?

CKD requires persistent structural or functional kidney abnormality for at least $3\,\text{months}$; an isolated reduction during an acute illness may represent AKI.

Which clinical scenario presents the strongest immediate indication for urgent dialysis evaluation?

A patient with refractory pulmonary edema and hypoxemia despite appropriate medical treatment.

What is the primary physiological disturbance in a CKD patient with $\text{pH } 7.29$, $\text{bicarbonate } 16\,\text{mEq/L}$, and $\text{PaCO}_2\text{ } 34\,\text{mm Hg}$?

Reduced renal acid excretion and impaired bicarbonate regeneration, producing a primary metabolic acidosis with respiratory compensation.

What primary mechanism causes anemia ($\text{hemoglobin } 8.8\,\text{g/dL}$) in an advanced CKD patient with adequate iron stores and no bleeding?

Reduced kidney production of erythropoietin, which diminishes bone marrow stimulation for red blood cell production.

When should a patient with chronic kidney disease take prescribed phosphate binders for them to be effective?

With meals and prescribed snacks so that the binder can bind dietary phosphorus directly in the gastrointestinal tract.

What is the recommended dietary management regarding protein for a patient transitioning from pre-dialysis CKD to maintenance hemodialysis?

Refer for a revised renal nutrition plan that increases protein intake to account for dialysis-related protein losses and metabolic demands.

Why are commercial salt substitutes containing potassium chloride contraindicated for a CKD patient with recurrent hyperkalemia?

They introduce significant exogenous potassium that the failing kidneys cannot excrete, directly worsening hyperkalemia.

What action must the nurse take before dialysis if an arteriovenous (AV) fistula has an absent thrill and an absent bruit, even though the hand is warm?

Notify the dialysis/vascular team promptly and avoid using the access, as this indicates loss of access flow or thrombosis.

Which extremity care plan is correct for a patient with a left-arm arteriovenous (AV) fistula requiring routine morning labs and blood pressure monitoring?

Use the right arm for blood pressure measurements and approved nonfistula sites for routine venipuncture, avoiding the fistula arm entirely.

Why can an arteriovenous (AV) fistula not be cannulated $10\,\text{days}$ post-creation even if a palpable thrill is present?

A thrill confirms flow, but the fistula requires roughly $2\text{ to }3\,\text{months}$ to mature in vessel caliber and wall thickness before cannulation is safe.

A patient undergoing hemodialysis develops nausea, dizziness, and a blood pressure of $78/44\,\text{mm Hg}$ after fluid removal. What is the immediate priority?

Alert the dialysis nurse immediately to manage ultrafiltration and blood pressure under protocol.

How much fluid has a maintenance hemodialysis patient retained if their pre-dialysis weight is $2.4\,\text{kg}$ above their dry postdialysis weight?

Approximately $2.4\,\text{L}$ of fluid, because $1\,\text{kg}$ of acute weight gain corresponds to roughly $1\,\text{L}$ of retained fluid.

What is the best initial nursing action if a peritoneal dialysis patient presents with cloudy drainage effluent, diffuse abdominal discomfort, and a temperature of $37.5\,^\circ\text{C}$?

Notify the dialysis team promptly and obtain effluent testing for suspected peritonitis.

What should the nurse do first when a peritoneal dialysis patient experiences inadequate drainage with no pain or fever, the drainage tubing is kinked, and the bag is level with the abdomen?

Correct the kink and position the collection bag below the abdomen to restore gravity drainage.

What are the correct initial and final steps for a 24-hour urine collection scheduled to start at $0700$?

Discard the $0700$ void on the start day, then collect all urine produced through and including the $0700$ void the following morning.

What action must be taken if a single void is accidentally discarded $18\,\text{hours}$ into an ordered 24-hour urine collection?

Notify the laboratory or healthcare provider and follow instructions about restarting the collection, as missing urine invalidates quantitative solute measurements.

How is a serum creatinine increase from $0.9$ to $2.1\,\text{mg/dL}$ interpreted in a patient who maintains a urine output of $1.5\,\text{L/day}$ following nephrotoxin exposure?

The patient has nonoliguric acute kidney injury; maintaining urine volume does not ensure adequate glomerular filtration or solute clearance.

Why is continuous renal replacement therapy (CRRT) selected over conventional intermittent hemodialysis for a patient with septic shock who requires vasopressors?

Its slower, continuous fluid and solute removal provides better hemodynamic stability in critically ill, hypotensive patients.

Which patient requires the nurse's immediate assessment: a patient with CKD, new restlessness, respiratory rate of $30\,\text{breaths/min}$, crackles, and an $\text{SpO}_2$ of $86\%$, or a patient with an absent AV fistula bruit?

The patient with CKD, restlessness, tachypnea, crackles, and an $\text{SpO}_2$ of $86\%$, as acute hypoxemia and pulmonary edema pose an immediate threat to the airway and breathing.