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The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient’s urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has:
- A. acute kidney injury from a prerenal condition.
- B. acute kidney injury from postrenal obstruction.
- C. intrarenal disease, probably acute tubular necrosis.
- D. a urinary tract infection.
Correct Answer: C
Rationale: The correct answer is C: intrarenal disease, probably acute tubular necrosis. The presence of coarse, muddy brown granular casts and hematuria in the urinalysis indicates damage to the renal tubules, which is characteristic of acute tubular necrosis. This condition is a type of intrarenal disease where there is direct damage to the kidney tubules, leading to decreased urinary output and symptoms like malaise and fatigue. Prerenal and postrenal conditions do not typically present with granular casts and hematuria, making choices A and B incorrect. Urinary tract infection is also unlikely to cause the specific findings seen in this case, ruling out choice D. Therefore, choice C is the most appropriate based on the urinalysis results and clinical presentation.
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Complications common to patients receiving hemodialysis for acute kidney injury include which of the following? (Select all that apply.)
- A. Hypotension
- B. Dysrhythmias
- C. Muscle cramps
- D. Hemolysis
Correct Answer: A
Rationale: The correct answer is A: Hypotension. Hemodialysis can lead to hypotension due to rapid fluid removal, causing a drop in blood pressure. This occurs as the dialysis machine removes excess fluid, affecting plasma volume. Hypotension can result in complications like dizziness, nausea, and potential cardiac issues. Dysrhythmias (B) are less common during hemodialysis for acute kidney injury. Muscle cramps (C) may occur due to electrolyte imbalances but are not as common as hypotension. Hemolysis (D) is not a common complication of hemodialysis but can occur if there are issues with the dialysis machine or blood tubing.
The patient is getting hemodialysis for the second time when he complains of a headache and nausea and, a little later, of becoming confused. The nurse realizes these are symptoms of
- A. dialyzer membrane incompatibility.
- B. a shift in potassium levels.
- C. dialysis disequilibrium syndrome.
- D. hypothermia.
Correct Answer: C
Rationale: The correct answer is C: dialysis disequilibrium syndrome. This syndrome occurs when there is a rapid shift in electrolytes, especially in the brain, due to the removal of waste products during hemodialysis. The symptoms of headache, nausea, and confusion align with this syndrome as the brain struggles to adjust to the changes. Dialyzer membrane incompatibility (A) is unlikely as it typically presents with allergic reactions, not neurological symptoms. A shift in potassium levels (B) may cause symptoms like muscle weakness or irregular heartbeat, not headache and confusion. Hypothermia (D) would present with low body temperature, shivering, and confusion, but in this case, the symptoms are more indicative of dialysis disequilibrium syndrome.
A patient presents to the emergency department with suspected thyroid storm. The nurse should be alert to which of the following cardiac rhythms while providing care to this patient?
- A. Atrial fibrillation
- B. Idioventricular rhythm
- C. Junctional rhythm
- D. Sinus bradycardia
Correct Answer: A
Rationale: The correct answer is A: Atrial fibrillation. In thyroid storm, excess thyroid hormone levels can lead to increased sympathetic activity, causing tachycardia and arrhythmias like atrial fibrillation. Atrial fibrillation is common in thyroid storm due to the hypermetabolic state and increased risk of atrial arrhythmias. Other choices are incorrect: B (Idioventricular rhythm) is not typically associated with thyroid storm, C (Junctional rhythm) is less likely since atrial arrhythmias are more common, and D (Sinus bradycardia) is unlikely due to the hypermetabolic state causing tachycardia.
A patient with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained: Glucose: 648 mg/dL pH: 88 P CO : 20 mm Hg a 2 P O : 95 mm Hg a 2 HCO ¯: undetectable Anion gap: >31 Na+: 127 mEq/L K+: 5 mEq/L Creatinine: 8 mg/dL After the patient’s airway and ventilation have been established, the next priority for this patient is:
- A. administration of a 1-L normal saline fluid bolus.
- B. administration of 0.1 unit of regular insulin IV push followed by an insulin infusion.
- C. administration of 20 mEq KCl in 100 mL.
- D. IV push administration of 1 amp of sodium bicarbonate.
Correct Answer: A
Rationale: The correct answer is A: administration of a 1-L normal saline fluid bolus. In this scenario, the patient is likely experiencing diabetic ketoacidosis (DKA) due to the extremely high glucose levels, low bicarbonate, and anion gap metabolic acidosis. The priority is to correct the dehydration and electrolyte imbalances through fluid resuscitation with normal saline to improve perfusion and reverse the metabolic derangements. Options B, C, and D do not address the immediate need for volume resuscitation and correction of dehydration. Administering insulin or potassium without first addressing the fluid deficit could lead to further complications. Sodium bicarbonate is not recommended in DKA as it can worsen acidosis and has not been shown to improve outcomes.
Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis
- A. is more frequently used for acute kidney injury.
- B. uses the patient’s own semipermeable membrane (peritoneal membrane).
- C. is not useful in cases of drug overdose or electrolyte imbalance.
- D. is not indicated in cases of water intoxication.
Correct Answer: B
Rationale: The correct answer is B because peritoneal dialysis uses the patient's own semipermeable membrane, the peritoneal membrane, to filter waste and excess fluid from the blood. This membrane allows for the exchange of fluids and solutes, making it an effective method for dialysis.
A is incorrect because peritoneal dialysis can be used for acute kidney injury.
C is incorrect as peritoneal dialysis can address drug overdose and electrolyte imbalance by removing toxins and balancing electrolytes.
D is incorrect as peritoneal dialysis can be used in cases of water intoxication by helping to remove excess fluid from the body.