A nurse on an acute medical unit of a hospital has admitted a 62 year old female from the emergency department who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching?

Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis

Most cases of acute pyelonephritis are attributable to poorly controlled hypertension

Flank pain, dysuria and nausea and vomiting are likely assessment findings

The infection in the kidney is most likely a manifestation of a systemic infection

Answer and Explanation

The Correct Answer is C

A. Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis: These findings are more typical of chronic pyelonephritis, which results from repeated or persistent kidney infections. Acute pyelonephritis usually presents with more subtle imaging changes.

B. Most cases of acute pyelonephritis are attributable to poorly controlled hypertension: While hypertension can complicate kidney disease, it is not a common cause of acute pyelonephritis. Most cases are due to ascending urinary tract infections, particularly from organisms like E. coli.

C. Flank pain, dysuria and nausea and vomiting are likely assessment findings: These are hallmark symptoms of acute pyelonephritis. Flank pain results from inflammation of the renal capsule, while dysuria and systemic symptoms like nausea, vomiting, and fever indicate infection.

D. The infection in the kidney is most likely a manifestation of a systemic infection: Acute pyelonephritis is typically caused by local ascending infections from the lower urinary tract, not systemic bacteremia. Though it can lead to systemic illness if not treated, its origin is usually localized.

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Correct Answer is ["C","D","E"]

Explanation

A. Optimizing pain: While pain management is important in any patient care plan, acute kidney injury typically does not cause significant pain unless associated with another condition such as obstruction or infection. It is not a primary focus unless the patient reports discomfort requiring intervention.

B. Protecting from falls: Fall prevention is a general safety measure but is not a specific priority related to AKI management unless the patient has associated risks like altered mental status, weakness, or dialysis-related hypotension. It is not a primary priority in early AKI care planning.

C. Monitoring electrolyte levels: AKI commonly leads to imbalances in potassium, sodium, calcium, and phosphorus due to impaired renal clearance. Hyperkalemia in particular poses serious cardiac risks, making electrolyte monitoring a top priority to prevent complications such as arrhythmias.

D. Assessing fluid balance: AKI affects the kidneys’ ability to excrete or conserve fluid, resulting in potential fluid overload or dehydration. Accurate intake and output tracking, daily weights, and edema assessment are essential to guide treatment and prevent respiratory or cardiovascular compromise.

E. Promoting infection control: Infection is both a potential cause and a complication of AKI, especially in hospitalized or catheterized patients. Maintaining strict aseptic technique, monitoring for signs of infection, and preventing sepsis are critical components of AKI management.

A. Calcium carbonate B. Sensipar (Cinacicet) C. Levothyroxine D. Vitamin D (Calcitrol)

Correct Answer is A

Explanation

A. Calcium carbonate: This is commonly used as a phosphate binder in patients with renal failure and hyperphosphatemia. It works by binding dietary phosphate in the gut, reducing its absorption, and thereby helping to lower serum phosphate levels.

B. Sensipar (Cinacalcet): Cinacalcet is used to treat secondary hyperparathyroidism in chronic kidney disease. It works by increasing the sensitivity of calcium-sensing receptors in the parathyroid gland to lower PTH levels.

C. Levothyroxine: This is a synthetic thyroid hormone used in the treatment of hypothyroidism. It does not have any role in managing phosphate levels in renal failure patients.

D. Vitamin D (Calcitriol): Calcitriol helps manage hypocalcemia and suppresses parathyroid hormone secretion in CKD. However, it may increase phosphate absorption from the gut, potentially worsening hyperphosphatemia if not carefully monitored.

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Naxlex Comprehensive Predictor Exams

You are planning the care for a client for a client with acute kidney injury (AKI). What should you prioritize in the client's plan of care? (Select all that apply)

Correct Answer is ["C","D","E"]

Explanation

Which of the following medications would you anticipate being prescribed for the renal failure patient who has hyperphosphatemia?

Correct Answer is A

Explanation

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