The nurse is caring for a patient with acute kidney injury that developed after a severe anaphylactic reaction. What is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient?

Maintain a mean arterial pressure of 65 mm Hg.

Prevent kidney infections by administering antibiotics.

Give antihistamines to prevent allergic response.

Correct fluid volume by administering IV normal saline.

Answer and Explanation

The Correct Answer is D

Rationale:
A. Maintaining a mean arterial pressure (MAP) of 65 mm Hg is important for ensuring adequate renal perfusion in general, but in the initial phase of acute kidney injury (AKI) following an anaphylactic reaction, the immediate priority is to restore intravascular volume. Hypotension from anaphylaxis causes decreased renal perfusion, which must be corrected first to prevent ischemic injury.
B. Antibiotics are not indicated unless there is a documented or suspected infection. In this scenario, the AKI is due to hemodynamic instability, not infection.
C. Antihistamines help manage the allergic response during the acute phase of anaphylaxis but do not directly prevent kidney damage once perfusion has already decreased.
D. The primary treatment goal during the initial phase of AKI secondary to anaphylaxis is to restore circulating blood volume and renal perfusion by administering IV isotonic fluids (normal saline). This helps maintain glomerular filtration rate (GFR), prevents tubular ischemia, and reduces the risk of permanent kidney damage. Fluid resuscitation is critical before considering vasopressors or other supportive measures.

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Correct Answer is D

Explanation

Rationale:
A. Checking distal pulses in the left arm is a safe and appropriate nursing action. It helps assess for adequate circulation beyond the AV fistula site and ensures that the vascular access has not compromised blood flow to the distal extremity.

B. Using the right arm for a blood pressure reading is appropriate and safe. Blood pressure measurements, venipunctures, or IV insertions should never be done on the arm with the AV fistula to avoid causing clot formation, vessel damage, or access loss.

C. Palpating the access site for a bruit or thrill is an important routine assessment to verify the patency and proper functioning of the fistula. The presence of a thrill (vibration) and bruit (swishing sound) indicates adequate blood flow through the access.

D. Administering intravenous fluids through the AV fistula is unsafe and contraindicated. The AV fistula must be used only for hemodialysis by trained personnel. Using it for IV fluids or medications increases the risk of infection, thrombosis, or permanent damage to the access site, which could compromise future dialysis treatments.

A. Increased edema in the legs B. Decreased calcium levels C. No adventitious sounds in the lungs D. Increased phosphorus levels

Correct Answer is C

Explanation

Rationale:
A. Increased edema in the legs indicates fluid retention, meaning the client’s fluid balance is not stable. Edema is a common sign of volume overload in clients with CKD who are not effectively maintaining fluid restriction.
B. Calcium levels reflect mineral and bone metabolism, not immediate fluid balance. Low calcium is common in CKD due to impaired vitamin D activation but does not indicate fluid stability.
C. The absence of adventitious lung sounds (such as crackles or rales) indicates that fluid has not accumulated in the lungs, suggesting stable fluid balance. In CKD, fluid overload can quickly lead to pulmonary edema, so clear lung sounds are an important clinical indicator that the client is maintaining appropriate fluid levels.
D. Increased phosphorus levels are related to decreased renal excretion of phosphate in CKD but do not reflect fluid balance.

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The nurse is caring for a patient with acute kidney injury that developed after a severe anaphylactic reaction. What is a primary treatment goal of the initial phase that will help to prevent permanent kidney damage for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The charge nurse is orienting a new nurse about care for an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?

Correct Answer is D

Explanation

A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the client's fluid balance is stable at this time?

Correct Answer is C

Explanation

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A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect?

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The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding?

A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?

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