Which of the following conditions would put a patient at risk for prerenal acute kidney injury?

dribbling of urine

vomiting and diarrhea for 3 days

difficulty starting urine stream

history of kidney stones

Answer and Explanation

The Correct Answer is B

A. Dribbling of urine is incorrect because this symptom is associated with postrenal causes of acute kidney injury, such as bladder outlet obstruction or urethral stricture. Postrenal AKI occurs when urine cannot exit the urinary tract properly, leading to backpressure on the kidneys. Prerenal AKI, in contrast, is caused by reduced kidney perfusion, not obstruction.

B. Vomiting and diarrhea for 3 days is correct because prolonged fluid loss leads to hypovolemia, which reduces circulating blood volume and renal perfusion. The kidneys rely on adequate blood flow to maintain glomerular filtration rate (GFR). When perfusion is decreased, the kidneys attempt to compensate by activating the renin-angiotensin-aldosterone system, but sustained hypoperfusion can lead to prerenal AKI. This type of AKI is potentially reversible if perfusion is restored promptly, making early recognition and fluid replacement critical. Conditions that commonly cause prerenal AKI include dehydration, hemorrhage, sepsis, heart failure, or severe fluid losses like vomiting and diarrhea.

C. Difficulty starting urine stream is incorrect because this symptom indicates a postrenal obstruction, such as benign prostatic hyperplasia or urethral stricture. In postrenal AKI, urine flow is blocked after it leaves the kidneys, causing backpressure and impaired renal function. This is different from prerenal AKI, where the problem originates before the kidneys due to reduced blood flow.

D. History of kidney stones is incorrect because kidney stones can lead to intermittent obstruction of urine flow, resulting in postrenal AKI. While kidney stones can compromise renal function if causing obstruction, they do not directly decrease renal perfusion and therefore are not a risk factor for prerenal AKI.

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Correct Answer is C

Explanation

A. APD requires manual exchanges during the day is incorrect because APD is automated, using a cycler machine to perform exchanges overnight, reducing the need for manual daytime exchanges. Some patients may also perform a daytime dwell, but it is not a requirementof APD.

B. APD cannot achieve adequate solute clearance is incorrect because APD can achieve adequate solute and fluid clearancewhen properly prescribed. The cycler controls the number of exchanges, dwell times, and volume, making it an effective alternative to continuous ambulatory peritoneal dialysis (CAPD).

C. APD is typically performed while the patient sleeps is correct. Automated peritoneal dialysis uses a cycler machine overnightto perform multiple exchanges, allowing the patient to remain free during the day. This provides convenience, improves quality of life, and maintains effective dialysis clearance.

D. APD uses a lower volume of dialysate than manual PD is incorrect because APD often uses larger volumes per exchangethan continuous ambulatory PD (CAPD), especially for patients requiring higher ultrafiltration. The cycler allows precise control of volume and timing.

A. Make sure patient is laying flat B. Close the drain to stop CSF drainage for 6 minutes C. Empty drainage tube D. Check patient's vital signs

Correct Answer is B

Explanation

A. Make sure patient is laying flat is incorrect because the head of the bed should generally be elevated to 30 degreesto promote venous drainage and reduce ICP. Laying flat may actually increase intracranial pressureand does not ensure an accurate ICP waveform reading.

B. Close the drain to stop CSF drainage for 6 minutes is correct because when the ventriculostomy is open to drain CSF, the ICP reading may not reflect true intracranial pressure, as CSF is continuously leaving the ventricles. To obtain an accurate ICP waveform, the nurse temporarily clamps or closes the drain for a short period (typically 5–10 minutes)while monitoring the patient, then documents the reading. This ensures the waveform reflects actual intracranial pressure rather than the pressure altered by ongoing drainage.

C. Empty drainage tube is incorrect because draining CSF from the collection chamber does not directly affect ICP waveform accuracy. The waveform represents ventricular pressure, and emptying the tube does not change the measurement as long as the system remains patent.

D. Check patient's vital signs is incorrect because while vital signs are important for overall assessment and detecting signs of increased ICP, they do not ensure an accurate ICP waveform reading. Vital signs can indicate changes secondary to ICP but are not a substitute for waveform assessment.

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Which of the following conditions would put a patient at risk for prerenal acute kidney injury?

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