AMSN Renal and Urological Disorders 1 — Questions and Answers
Question 1: A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and peaked T waves on ECG. The nurse's priority action is:
- Restrict dietary potassium intake only
- Prepare to administer calcium gluconate and notify the provider immediately (Correct answer)
- Encourage increased fluid intake
- Administer a potassium supplement
Correct answer: Prepare to administer calcium gluconate and notify the provider immediately
Hyperkalemia with ECG changes is a cardiac emergency; calcium gluconate is administered first to stabilize the myocardium while definitive treatment is arranged.
Question 2: A patient with chronic kidney disease (CKD) stage 4 asks why they need to restrict dietary phosphorus. The best response is:
- 'High phosphorus increases your blood pressure.'
- 'Your kidneys cannot excrete phosphorus well, which causes it to build up and leach calcium from bones.' (Correct answer)
- 'Phosphorus restriction prevents potassium from rising.'
- 'Low phosphorus diets prevent kidney stones.'
Correct answer: 'Your kidneys cannot excrete phosphorus well, which causes it to build up and leach calcium from bones.'
In CKD, impaired phosphorus excretion leads to hyperphosphatemia, which stimulates PTH release and causes calcium to be pulled from bone (renal osteodystrophy).
Question 3: A patient with nephrotic syndrome has 4+ pitting edema and serum albumin of 1.8 g/dL. The edema is primarily caused by:
- Increased aldosterone secretion
- Loss of albumin in urine reducing plasma oncotic pressure (Correct answer)
- Excessive sodium intake
- Right-sided heart failure
Correct answer: Loss of albumin in urine reducing plasma oncotic pressure
Massive protein (albumin) loss in urine lowers plasma oncotic pressure, allowing fluid to shift into the interstitium, causing profound edema.
Question 4: A patient with a urinary tract infection (UTI) is prescribed trimethoprim-sulfamethoxazole (TMP-SMX). The nurse should instruct the patient to:
- Take the full course of antibiotics even if symptoms resolve (Correct answer)
- Stop taking the medication once symptoms resolve to prevent resistance
- Take the medication only at bedtime
- Avoid drinking water to concentrate the medication
Correct answer: Take the full course of antibiotics even if symptoms resolve
Completing the full antibiotic course eradicates the infection completely and prevents recurrence and antibiotic resistance.
Question 5: A patient on hemodialysis reports shortness of breath and a 4 kg weight gain since the last dialysis session. The nurse's priority assessment is:
- Blood glucose level
- Lung sounds and oxygen saturation (Correct answer)
- Neurological status
- Skin turgor
Correct answer: Lung sounds and oxygen saturation
Rapid weight gain between dialysis sessions indicates fluid overload; dyspnea and crackles on auscultation suggest pulmonary edema requiring urgent assessment.
Question 6: Which dietary restriction is essential for a patient with end-stage renal disease (ESRD) on hemodialysis?
- Restrict calcium and vitamin C only
- Restrict potassium, phosphorus, sodium, and fluid intake (Correct answer)
- Increase protein to compensate for dialysis losses
- Restrict all fruits and vegetables permanently
Correct answer: Restrict potassium, phosphorus, sodium, and fluid intake
ESRD patients on hemodialysis must restrict potassium (arrhythmia risk), phosphorus (bone disease), sodium (fluid retention), and fluids (pulmonary edema risk).
AMSN Renal and Urological Disorders 1
A patient with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and peaked T waves on ECG.
The nurse's priority action is: