Which statement regarding acute prerenal failure (prerenal acute kidney injury) is true?

It usually involves tubule damage.

The kidneys are unable to retain sodium and water.

It seldom affects glomerular filtration of blood.

The hallmark characteristic is renal hypoperfusion.

Answer and Explanation

The Correct Answer is D

A. It usually involves tubule damage: Tubular damage is characteristic of intrinsic (intrarenal) acute kidney injury, not prerenal AKI. In prerenal failure, the kidney structure is initially intact, and injury results primarily from reduced perfusion.

B. The kidneys are unable to retain sodium and water: In prerenal AKI, the kidneys are still functional and attempt to conserve sodium and water to maintain intravascular volume. Inability to retain sodium and water is more typical of intrinsic kidney injury.

C. It seldom affects glomerular filtration of blood: Prerenal AKI directly reduces glomerular filtration rate (GFR) due to decreased renal perfusion. Saying it “seldom affects GFR” is incorrect because a drop in GFR is central to prerenal failure.

D. The hallmark characteristic is renal hypoperfusion: Reduced renal blood flow is the defining feature of prerenal AKI. Causes include dehydration, hemorrhage, heart failure, or shock, and the primary problem is insufficient perfusion rather than structural kidney damage.

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Correct Answer is A

Explanation

A. Ventricular fibrillation and pulseless ventricular tachycardia: Both of these rhythms are considered shockable because they result in no effective cardiac output and can rapidly lead to death. Defibrillation delivers an unsynchronized electrical shock to depolarize the myocardium and restore a perfusing rhythm.

B. Ventricular fibrillation and pulseless electrical activity: Pulseless electrical activity is not a shockable rhythm. It involves organized electrical activity without mechanical cardiac output, so defibrillation is ineffective. Treatment focuses on CPR and addressing the underlying cause rather than delivering a shock.

C. Ventricular fibrillation and asystole: Asystole represents a flatline with no electrical or mechanical activity and is not shockable. Defibrillation will not restart cardiac activity; instead, CPR and pharmacologic interventions are prioritized. Only ventricular fibrillation in this pair is shockable.

D. Pulseless ventricular tachycardia and atrial fibrillation: Pulseless ventricular tachycardia is shockable, but atrial fibrillation is not typically treated with emergent defibrillation unless the patient is unstable and requires synchronized cardioversion. Atrial fibrillation is generally managed with rate or rhythm control, not immediate defibrillation.

A. Elevate head of bed 30 to 45 degrees if not contraindicated B. Administration of IV antibiotics routinely C. Changing ventilator circuit tubing every 72 hours D. Routine prone positioning

Correct Answer is A

Explanation

A. Elevate head of bed 30 to 45 degrees if not contraindicated: Elevating the head of the bed helps reduce the risk of aspiration of gastric contents, which is a primary cause of ventilator-associated pneumonia. This simple positioning strategy is evidence-based and widely recommended in VAP prevention bundles.

B. Administration of IV antibiotics routinely: Routine prophylactic antibiotics are not recommended because they do not prevent VAP and may promote antibiotic resistance. Antibiotics should be reserved for treatment of confirmed infections, not routine prevention.

C. Changing ventilator circuit tubing every 72 hours: Frequent scheduled changes of ventilator circuits have not been shown to reduce VAP incidence and may increase the risk of contamination. Tubing should only be changed if visibly soiled or malfunctioning.

D. Routine prone positioning: Prone positioning is used selectively for clients with severe ARDS to improve oxygenation, not as a routine VAP prevention strategy. While beneficial for gas exchange, it does not specifically reduce the risk of ventilator-associated pneumonia.

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Which statement regarding acute prerenal failure (prerenal acute kidney injury) is true?

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