Question 1

The risk for contrast media-induced acute tubular necrosis (ATN)is highest in

Accepted Answer

This patient with the highest risk has two risk factors for contrast media-induced ATN: age over 70 and co-existing heart failure.The other patients have no risk factors for contrast media-induced ATN.

Question 2

The most likely cause of anemia in a patient with end-stage renal disease is

Accepted Answer

The most likely cause of anemia in a patient with end-stage renal disease is insufficient erythropoietin secretion by the kidney,which is necessary for RBC production.Blood loss secondary to hematuria,vitamin B₁₂ deficiency secondary to deficient intrinsic factor,and iron deficiency are not the most likely causes of anemia in a patient with end-stage renal disease.

Question 3

The oliguric phase of acute tubular necrosis is characterized by

Accepted Answer

The oliguric phase of ATN is characterized by fluid excess and electrolyte imbalance.Fever and diminishing cognition are not typical manifestations of ATN oliguric phase.During this phase sodium is lost in the urine and potassium is not excreted,and magnesium and phosphorous are retained in the body.

Question 4

If acute tubular necrosis (ATN)does not resolve and continued tubular dysfunction ensues,the patient will then experience

Accepted Answer

If ATN does not resolve,the high blood urea nitrogen (BUN)creates osmotic diuresis; the urine is high in sodium content.Oliguria and sodium retention,infections and sepsis,and magnesium and phosphorous loss in the urine do not result from tubular necrosis and tubular dysfunction.

Question 5

In patients with polycystic kidney disease,renal failure is expected to progress over time as the cystic process destroys more nephrons.At what point will a patient reach end-stage renal disease?

Accepted Answer

End-stage renal disease occurs when greater than 90% of the nephrons have been lost.End-stage renal disease is possible to predict based on nephron loss.It occurs when greater than 90% (not 15%,25%,or 50%)of the nephrons have been lost.

Question 6

At his most recent clinic visit,a patient with end-stage renal disease is noted to have edema,congestive signs in the pulmonary system,and a pericardial friction rub.Appropriate therapy at this time would include

Accepted Answer

Dialysis is the appropriate therapy at end-stage renal disease.Although fluid restriction may be appropriate at some point in renal failure,it will not correct the identified problems.Antibiotics will not correct the problems identified and may further impair remaining renal function.Phlebotomy will not correct the identified problems.

Question 7

The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN)in hospitalized patients is

Accepted Answer

The most common agent resulting in nephrotoxicity and subsequent ATN is contrast media.Contrast media,cancer chemotherapy,and recreational drugs are not the most common agents resulting in nephrotoxicity and subsequent ATN.

Question 8

The most likely cause of acidosis in a patient with end-stage renal disease is

Accepted Answer

The most likely cause of acidosis in a patient with end-stage renal disease is insufficient metabolic acid excretion resulting from nephron loss.Insufficient filtration of bicarbonate at the glomerulus would lead to alkalosis,not acidosis.Excessive production of respiratory acids would lead to respiratory acidosis not metabolic acidosis.The problem is metabolic acids are not excreted.Hypoventilation secondary to uremic CNS depression may occur,but this would lead to respiratory acidosis,not metabolic acidosis.

Question 9

Appropriate management of end-stage renal disease includes

Accepted Answer

Erythropoietin administration is appropriate,as the kidneys are not able to secrete erythropoietin.Potassium is not appropriate,as the kidneys are unable to excrete potassium.A high-protein diet is not appropriate,as the kidneys are unable to excrete urea.A high-phosphate diet is not appropriate,as the kidneys are unable to excrete phosphorous.

Question 10

The most helpful laboratory value in monitoring the progression of declining renal function is

Accepted Answer

Serum creatinine is the most stable and accurate reflection of renal function.Serum potassium is affected by many factors and thus not the most helpful value in monitoring the progression of this disease.Blood urea nitrogen is not as stable as serum creatinine; it is affected by muscle breakdown,protein intake,and so forth.Mental status changes can occur as a result of multiple factors other than renal function.

Question 11

Appropriate therapy for prerenal kidney injury includes

Accepted Answer

Appropriate therapy for prerenal oliguria includes fluid administration; most often prerenal kidney injury is because of fluid volume deficit.Potassium supplements are not appropriate in prerenal oliguria,as potassium is not being excreted.Appropriate therapy for prerenal oliguria includes fluid administration.Protein restriction is not indicated in prerenal oliguria.

Question 12

One of the most common causes of acute tubular necrosis (ATN)is

Accepted Answer

Ischemia and nephrotoxic agents are the most common causes of ATN.Cytotoxic agents,immune reaction,and prolonged postrenal kidney injury are not the most common causes of ATN.

Question 13

Gastrointestinal drainage,perioperative and postoperative hypotension,and hemorrhage may all contribute to renal failure by causing

Accepted Answer

Gastrointestinal drainage,perioperative and postoperative hypotension,and hemorrhage may all contribute to renal failure by causing acute tubular necrosis.Gastrointestinal drainage,perioperative and postoperative hypotension,and hemorrhage do not cause hydronephrosis,nephrosis,or renal inflammation.

Question 14

What problem is a patient likely to experience in end-stage renal disease?

Accepted Answer

Uremia occurs in end-stage renal disease because the kidneys cannot excrete urea,the end product of protein metabolism.Hyperkalemia occurs in end-stage renal disease.Polyuria and nocturia do not occur in end-stage renal disease; the kidneys are unable to excrete urine.Hematuria does not generally occur unless another problem is causing it.

Question 15

Osteoporosis commonly occurs in patients with end-stage renal disease because of

Accepted Answer

Osteoporosis commonly occurs in patients with end-stage renal disease because of hyperparathyroidism.Hypocalcemia occurs in end-stage renal disease.Insufficient active vitamin D would result in osteoporosis.Phosphate is retained in end-stage renal disease.

Question 16

The most common cause of ischemic acute tubular necrosis (ATN)in the United States is

Accepted Answer

Sepsis is the most common cause of ischemic ATN in the United States.Hypotension,hypovolemia,and renal artery stenosis are not the most common causes of ischemic ATN.

Question 17

One of the most frequent causes of chronic kidney disease is

Accepted Answer

Hypertension and diabetes are the most common causes of chronic kidney disease.Although glomerulonephritis,chronic pyelonephritis,and polycystic kidney disease can result in CKD,hypertension and diabetes are the most common causes of chronic kidney disease.

Question 18

A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate,because

Accepted Answer

A patient with renal disease is at risk for developing uremia as his nephrons progressively deteriorate because GFR declines.The basement membrane does not become increasingly permeable.Filtration does not exceed secretory and reabsorptive capacity.Excessive solute and water are not lost in the urine.

Question 19

The most common cause of intrinsic kidney injury is _____ injury.

Accepted Answer

Tubular injury (acute tubular necrosis)is the most common cause of acute kidney injury.Glomerular,interstitial,and vascular injury are not the most common causes of acute kidney injury.

Question 20

Which intervention has been found to retard the advancement of chronic kidney disease?

Accepted Answer

ACE inhibitors or A-II receptor blockers have been found to retard the advancement of chronic kidney disease by reducing proteinuria.Calcium supplementation,erythropoietin,and insulin have not been found to retard the advancement of chronic kidney disease.

Quiz 28: Acute Kidney Injury and Chronic Kidney Disease

The risk for contrast media-induced acute tubular necrosis (ATN) is highest in