Answer-Integrated Exam Saunders NCLEX-
RN 8th Edition 2024/2025
The nurse is performing assessment on a client with acute kidney injury who is in the oliguric
phase. Which should the nurse expect to note? Select all that apply.
1.Increased serum creatinine level
2.A low and fixed specific gravity
3.Increased blood urea nitrogen (BUN) level
4.A urine output of 600 to 800 mL in a 24-hour period
5.Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)
1.Increased serum creatinine level
2.A low and fixed specific gravity
3.Increased blood urea nitrogen (BUN) level
5.Urine osmolarity of approximately 300 mOsm/kg (300 mmol/kg)
Increased blood urea nitrogen (BUN) level Urine osmolarity of approximately 300 mOsm/L Rationale:
During the oliguric phase of acute kidney injury, serum creatinine levels increase by approximately 1
mg/dL per day, and the BUN level increases by approximately 20 mg/dL per day. The specific gravity of
the urine is low and fixed, and the urine osmolarity approaches that of the client's serum level, or about
300 mOsm/L. Urine output is less than 100 mL in a 24-hour period.
The nurse is caring for a client with acute kidney injury (AKI). The nurse should test the client's urine
for proteinuria to determine which type of AKI?
1.Prerenal 2.Intrinsic 3.Atypical 4.Postrenal
2. Intrinsic
In intrinsic failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In prerenal
failure, the specific gravity is high, and there is very little or no proteinuria. In postrenal failure, there is a
fixed specific gravity and little or no proteinuria. There is no disorder known as atypical renal failure.
The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The
client has an intravenous (IV) infusion at a rate of 150 mL/hour, unchanged for the last 10 hours. The
client's urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The
,client's blood urea nitrogen level is 35 mg/dL (12.6 mmol/L), and the serum creatinine level is 1.8
mg/dL (159 mcmol/L), measured this morning. Which nursing action is the priority?
1.Check the urine specific gravity.
2.Call the primary health care provider (PHCP). 3.Put the IV line on a pump so that the infusion rate is
sure to stay stable.
4.Check to see if the client had a blood sample for a serum albumin level drawn.
2.Call the primary health care provider (PHCP).
Call the health care provider. *Following abdominal aortic aneurysm resection or repair, monitor for
acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery
and depending on the aneurysm location they renal arteries may be hypo-perfused for a short period of
time.
The nursing student is assigned to care for a client with a diagnosis of acute kidney injury (AKI), diuretic
phase. The nursing instructor asks the student about the primary goal of the treatment plan for this
client. Which goal, if stated by the nursing student, indicates an adequate understanding of the
treatment plan for this client?
1.Prevent fluid overload.
2.Prevent loss of electrolytes.
3.Promote the excretion of wastes.
4.Reduce the urine specific gravity.
2.Prevent loss of electrolytes.
In the diuretic phase, fluids and electrolytes are lost in the urine. As a result, the plan of care focuses on
fluid and electrolyte replacement and monitoring. Options 1, 3, and 4 are not the primary concerns in
this phase of AKI.
The nurse is caring for a client who has been diagnosed as having an acute kidney injury (AKI) due
to intrarenal causes. What diagnostic test is most effective in confirming this diagnosis?
1.Renal biopsy
2.Ultrasonography
3.Computed tomography scan
4.Magnetic resonance imaging
1.Renal biopsy
,Rationale: A renal biopsy is considered the best method for confirming intrarenal causes of acute kidney
injury (AKI). Magnetic resonance imaging (MRI) and computed tomography (CT) scans contain contrast
mediums that can be harmful to clients with this condition. An ultrasound study is not definitive and
may not provide enough information.
A client with glomerulonephritis has developed acute kidney injury (AKI) as a complication. The nurse
should expect to note which abnormal finding documented on the client's medical record?
1.Bradycardia
2.Hypertension
3.Decreased cardiac output
4.Decreased central venous pressure
2. Hypertension
AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI
commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid
overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of
the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not
part of the clinical picture for any form of renal failure.
A client has developed acute kidney injury (AKI) as a complication of glomerulonephritis. Which should
the nurse expect to observe in the client?
1.Bradycardia 2.Hypertension 3.Decreased cardiac output 4.Decreased central venous pressure
2.Hypertension
Rationale: AKI caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of AKI
commonly manifests with hypertension, tachycardia, oliguria, lethargy, edema, and other signs of fluid
overload. AKI from prerenal causes is characterized by decreased blood pressure or a recent history of
the same, tachycardia, and decreased cardiac output and central venous pressure. Bradycardia is not
part of the clinical picture for any form of renal failure.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2
hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent
hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16
mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the
nurse would anticipate that the client is at risk for which problem?
1.Hypovolemia
2.Acute kidney injury
3.Glomerulonephritis
, 4.Urinary tract infection
2.Acute kidney injury
Rationale: The client who undergoes cardiac surgery is at risk for renal injury from poor perfusion,
hemolysis, low cardiac output, or vasopressor medication therapy. Renal injury is signaled by decreased
urine output and increased blood urea nitrogen (BUN) and creatinine levels. Normal reference levels are
BUN, 10 to 20 mg/dL (3.6 to 7.1 mmol/L), and creatinine, male, 0.6 to 1.2 mg/dL (53 to 106 mcmol/L)
and female 0.5 to 1.1 mg/dL (44 to 97 mcmol/L). The client may need medications to increase renal
perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in the question indicate
the presence of hypovolemia, glomerulonephritis, or urinary tract infection.
A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The nurse
should plan which actions as a priority? Select all that apply.
1.Place the client on a cardiac monitor.
2.Notify the primary health care provider (PHCP). 3.Put the client on NPO (nothing by mouth) status
except for ice chips.
4.Review the client's medications to determine if any contain or retain potassium.
5.Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration.
1.Place the client on a cardiac monitor.
2.Notify the health care provider (HCP).
4.Review the client's medications to determine if any contain or retain potassium.
The normal potassium level is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). A potassium level of 7.0 is elevated. The
client with hyperkalemia is at risk of developing cardiac dysrhythmias and cardiac arrest. Because of this,
the client should be placed on a cardiac monitor. The nurse should notify the HCP and also review
medications to determine if any contain potassium or are potassium retaining. The client does not need
to be put on NPO status. Fluid intake is not increased because it contributes to fluid overload and would
not affect the serum potassium level significantly.
The nurse checks the serum myoglobin level for a client with a crush injury to the right lower leg
because the client is at risk for developing which type of acute kidney injury?
1.Prerenal 2.Postrenal 3.Intrarenal 4.Extrarenal
3. Intrarenal
Serum myoglobin levels increase in crush injuries when large amounts of myoglobin and hemoglobin are
released from damaged muscle and blood cells. The accumulation may cause acute tubular necrosis, an
intrarenal cause of renal failure. Prerenal causes are conditions that interfere with the perfusion of
blood to the kidney. Postrenal causes include conditions that cause urinary obstruction distal to the
kidney. The cause and the type of renal failure may determine the interventions used in treatment.
