acute kidney injury

Question

The nurse cares for an adult client. Review the note and answer the six questions.

Step 1

Which findings should the nurse report as relevant to possible kidney injury? Select all that apply.

1. AVery little urine over the last day✓ Correct

   Markedly reduced urine output needs prompt review.

2. BRepeated vomiting and poor fluid intake✓ Correct

   Fluid loss and reduced intake can contribute to volume depletion.

3. CA preference for quiet music✗ Incorrect

   Music preference does not indicate kidney injury.

4. DA request for an extra pillow✗ Incorrect

   The request alone does not establish a renal change.

5. EUse of a personal calendar✗ Incorrect

   This habit does not explain the low output.

Rationale. Markedly reduced urine output and fluid losses together raise concern for kidney function. Further evaluation is needed.

Step 2

How might the fluid losses affect the kidneys?

1. AReduced circulating volume can diminish kidney perfusion✓ Correct

   Insufficient volume can limit blood flow to the kidneys.

2. BVomiting always increases kidney filtration✗ Incorrect

   Volume depletion can reduce filtration.

3. CLow urine output proves that the kidneys are unaffected✗ Incorrect

   Low output can accompany impaired kidney function.

4. DFluid loss always increases circulating volume✗ Incorrect

   Fluid losses can reduce circulating volume.

Rationale. Loss of circulating volume can impair blood delivery to the kidneys. Filtration can fall when renal perfusion decreases.

Step 3

Which possible problem should the nurse raise for urgent evaluation?

1. APossible kidney injury related to volume depletion✓ Correct

   Low output and fluid losses make this a plausible concern.

2. BA confirmed urinary obstruction✗ Incorrect

   The note does not establish an obstruction.

3. CNormal urine elimination for every adult✗ Incorrect

   The reported output is markedly low.

4. DA resolved fluid deficit✗ Incorrect

   The low urine output does not establish that the fluid deficit has resolved.

Rationale. Very low output after fluid losses raises concern for acute kidney injury. The cause and severity need clinical assessment.

Step 4

Which information would best help the team assess the fluid problem?

1. AAccurate fluid intake and urine output records✓ Correct

   These measurements help the team follow the fluid problem.

2. BThe client’s preferred music✗ Incorrect

   This does not quantify fluid balance.

3. CThe color of the room curtains✗ Incorrect

   This does not measure fluid intake or output.

4. DThe time of the next television program✗ Incorrect

   This does not assess the renal concern.

Rationale. Recording intake and output gives the team data on the fluid balance. The urine trend is especially relevant here.

Step 5

What should the nurse do with the new output finding?

1. AReport the low output promptly and continue measuring intake and output✓ Correct

   Escalation and ongoing measurement support timely assessment.

2. BWait until discharge to share the measurement✗ Incorrect

   Deferring the report could delay care.

3. CDiscard the output record and estimate later✗ Incorrect

   This loses useful objective data.

4. DAssume that the client’s usual output has returned✗ Incorrect

   The documented finding does not support that assumption.

Rationale. A pronounced drop in urine output after fluid loss warrants prompt communication. Measurements should continue so the team can follow the trend.

Step 6

After treatment for the fluid deficit, which trend is most reassuring?

1. AUrine output increases toward the client’s prior pattern✓ Correct

   This moves away from the reported reduction.

2. BUrine output continues to fall✗ Incorrect

   A further decrease needs reassessment.

3. CVomiting continues and no urine is recorded✗ Incorrect

   Persistent losses and absent recorded output remain concerning.

4. DIntake and output measurements are stopped✗ Incorrect

   Missing data cannot establish an improving trend.

Rationale. Adult urine output normally ranges from one to two liters daily. Intake and output measurements can be monitored during illness or urinary conditions.

Rationale

Fluid loss and markedly low urine output warrant prompt evaluation. Ongoing measurements help the team follow the response.