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A client with a history of chronic kidney disease (CKD) is receiving erythropoietin therapy. Which laboratory value should the nurse monitor closely?
- A. Serum potassium level
- B. White blood cell count
- C. Hemoglobin level
- D. Serum calcium level
Correct Answer: A
Rationale: The correct answer is A: Serum potassium level. In a client receiving erythropoietin therapy for chronic kidney disease, monitoring serum potassium levels is crucial due to the risk of hyperkalemia. Erythropoietin can stimulate red blood cell production, leading to an increased demand for potassium. Monitoring potassium levels helps prevent complications associated with hyperkalemia. Choices B, C, and D are incorrect because erythropoietin therapy specifically impacts potassium levels, not white blood cell count, hemoglobin level, or serum calcium level.
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A client with a traumatic brain injury becomes progressively less responsive to stimuli. The client has a 'Do Not Resuscitate' prescription, and the nurse observes that the unlicensed assistive personnel (UAP) has stopped turning the client from side to side as previously scheduled. What action should the nurse take?
- A. Advise the UAP to resume positioning the client on schedule
- B. Notify the healthcare provider
- C. Document the UAP's actions
- D. Discuss the situation with the client's family
Correct Answer: A
Rationale: Continuing to turn the client is crucial to prevent complications such as pressure ulcers, even if the client is less responsive. Advising the UAP to resume positioning the client on schedule is the most appropriate action in this situation. This action ensures that the client's care needs are met and helps prevent potential complications. Notifying the healthcare provider or documenting the UAP's actions may delay the necessary care for the client. Discussing the situation with the client's family is important but addressing the immediate care need of turning the client takes priority.
In caring for a client with a PCA infusion of morphine sulfate through the right cephalic vein, the nurse assesses that the client is lethargic with a blood pressure of 90/60, pulse rate of 118 beats per minute, and respiratory rate of 8 breaths per minute. What assessment should the nurse perform next?
- A. Note the appearance and patency of the client's peripheral IV site.
- B. Palpate the volume of the client's right radial pulse.
- C. Auscultate the client's breath sounds bilaterally.
- D. Observe the amount and dose of morphine in the PCA pump syringe.
Correct Answer: D
Rationale: In this scenario, the nurse is dealing with a lethargic client with concerning vital signs after a PCA infusion of morphine sulfate. The next assessment the nurse should perform is to observe the amount and dose of morphine in the PCA pump syringe. This is crucial to evaluate for possible overdose, as the client's symptoms could be indicative of opioid toxicity. Checking the morphine amount and dose will help the nurse adjust the treatment accordingly. Choices A, B, and C do not directly address the potential cause of the client's lethargy and abnormal vital signs related to the morphine infusion.
A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which laboratory value is most concerning?
- A. Serum potassium of 6.5 mEq/L
- B. Serum sodium of 135 mEq/L
- C. Serum creatinine of 2.0 mg/dl
- D. Blood glucose of 150 mg/dl
Correct Answer: A
Rationale: A serum potassium level of 6.5 mEq/L is concerning in a client with CKD as it indicates hyperkalemia, which requires immediate intervention to prevent cardiac complications. Hyperkalemia can lead to life-threatening arrhythmias, particularly in patients with impaired kidney function. Serum sodium, creatinine, and blood glucose levels, while important, are not as acutely dangerous as severe hyperkalemia in this context.
The nurse is assessing a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which clinical finding requires immediate intervention?
- A. Increased fatigue
- B. Elevated blood pressure
- C. Headache
- D. Elevated hemoglobin
Correct Answer: A
Rationale: The correct answer is A, 'Increased fatigue.' In a client with CKD receiving erythropoietin therapy, increased fatigue can be a sign of polycythemia, a condition characterized by an elevated red blood cell count. This can lead to increased blood viscosity and raise the risk of thromboembolic events, necessitating immediate intervention. Elevated blood pressure (choice B) is a common concern in CKD but does not require immediate intervention in this context. Headache (choice C) may be related to elevated blood pressure but is not the most critical finding requiring immediate attention. Elevated hemoglobin (choice D) is an expected outcome of erythropoietin therapy and does not require immediate intervention unless excessively high.
A client with a history of chronic kidney disease is scheduled for a renal biopsy. Which laboratory value should the nurse report to the healthcare provider before the procedure?
- A. Serum creatinine of 1.8 mg/dl
- B. Prothrombin time of 18 seconds
- C. Hemoglobin of 9 g/dl
- D. Platelet count of 90,000/mm3
Correct Answer: D
Rationale: A platelet count of 90,000/mm3 is low and concerning for a client scheduled for a renal biopsy, as it increases the risk of bleeding. Thrombocytopenia, indicated by a low platelet count, can lead to impaired blood clotting, posing a significant risk of bleeding during or after the biopsy procedure. Elevated serum creatinine levels may be expected in chronic kidney disease but are not directly related to bleeding risk during a renal biopsy. Prothrombin time and hemoglobin levels are not as directly relevant to the bleeding risk associated with a renal biopsy as platelet count.