The clinical nurse educator on a nephrology unit of a large, ...

[abc]

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit.
 
  Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session?
  A)
  The cardinal signs of ATN are oliguria and retention of potassium, creatinine, and sulfates.
  B)
  Ureteral and bladder outlet obstructions are often contributors to ATN.
  C)
  Trauma, burns, and major surgery are common precursors to ATN.
  D)
  Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible.

Question 2

A 31-year-old client with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital.
 
  Arterial blood sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH?
  A)
  Conservation or formation of new HCO3- by the kidneys
  B)
  Low albumin and plasma globulin levels
  C)
  Transcompartmental exchange of H+ and potassium ions
  D)
  Renal excretion of HCO3- in the presence of excess base

[momtoalll]

Answer to Question 1

Ans:
C

Feedback:

ATN is often preceded by major surgery, burns, or trauma. Many cases of ATN are nonoliguric, and obstructions that are postrenal in nature are not common causes of ATN. Damage to tubular epithelial cells is not necessarily irreversible.

Answer to Question 2

Ans:
B

Feedback:

Albumin and plasma globulins are key protein buffers in the vascular compartment; consequently, a low albumin level, as is common in liver failure, is apt to result in acid-base imbalances. Answer choices A, C, and D all convey normal physiological processes that help to maintain pH.