Nokea
A patient is scheduled for a CT scan of the abdomen with contrast. The patient has a baseline creatinine level of 2.3 mg/dL. In preparing this patient for the procedure, the nurse anticipates what orders?
- A. Monitor the patients electrolyte values every hour before the procedure.
- B. Preprocedure hydration and administration of acetylcysteine
- C. Hemodialysis immediately prior to the CT scan
- D. Obtain a creatinine clearance by collecting a 24-hour urine specimen.
Correct Answer: B
Rationale: Radiocontrast-induced nephropathy is a major cause of hospital-acquired acute kidney injury. Baseline levels of creatinine greater than 2 mg/dL identify the patient as being high risk. Preprocedure hydration and prescription of acetylcysteine (Mucomyst) the day prior to the test is effective in prevention. The nurse would not monitor the patients electrolytes every hour preprocedure. Nothing in the scenario indicates the need for hemodialysis. A creatinine clearance is not necessary prior to a CT scan with contrast.
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A patient with chronic kidney disease has been hospitalized and is receiving hemodialysis on a scheduled basis. The nurse should include which of the following actions in the plan of care?
- A. Ensure that the patient moves the extremity with the vascular access site as little as possible.
- B. Change the dressing over the vascular access site at least every 12 hours.
- C. Utilize the vascular access site for infusion of IV fluids.
- D. Assess for a thrill or bruit over the vascular access site each shift.
Correct Answer: D
Rationale: The bruit, or thrill, over the venous access site must be evaluated at least every shift. Frequent dressing changes are unnecessary and the patient does not normally need to immobilize the site. The site must not be used for purposes other than dialysis.
A 71-year-old patient with ESKD has been told by the physician that it is time to consider hemodialysis until a transplant can be found. The patient tells the nurse she is not sure she wants to undergo a kidney transplant. What would be an appropriate response for the nurse to make?
- A. The decision is certainly yours to make, but be sure not to make a mistake.
- B. Kidney transplants in patients your age are as successful as they are in younger patients.
- C. I understand your hesitancy to commit to a transplant surgery. Success is comparatively rare.
- D. Have you talked this over with your family?
Correct Answer: B
Rationale: Although there is no specific age limitation for renal transplantation, concomitant disorders (e.g., coronary artery disease, peripheral vascular disease) have made it a less common treatment for the elderly. However, the outcome is comparable to that of younger patients. The other listed options either belittle the patient or give the patient misinformation.
The nurse is caring for a patient with a history of systemic lupus erythematosus who has been recently diagnosed with end-stage kidney disease (ESKD). The patient has an elevated phosphorus level and has been prescribed calcium acetate to bind the phosphorus. The nurse should teach the patient to take the prescribed phosphorus-binding medication at what time?
- A. Only when needed
- B. Daily at bedtime
- C. First thing in the morning
- D. With each meal
Correct Answer: D
Rationale: Both calcium carbonate and calcium acetate are medications that bind with the phosphate and assist in excreting the phosphate from the body, in turn lowering the phosphate levels. Phosphate-binding medications must be administered with food to be effective.
The nurse is caring for a patient in acute kidney injury. Which of the following complications would most clearly warrant the administration of polystyrene sulfonate (Kayexalate)?
- A. Hypernatremia
- B. Hypomagnesemia
- C. Hyperkalemia
- D. Hypercalcemia
Correct Answer: C
Rationale: Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels.
The nurse is creating an education plan for a patient who underwent a nephrectomy for the treatment of a renal tumor. What should the nurse include in the teaching plan?
- A. The importance of increased fluid intake
- B. Signs and symptoms of rejection
- C. Inspection and care of the incision
- D. Techniques for preventing metastasis
Correct Answer: C
Rationale: The nurse teaches the patient to inspect and care for the incision and perform other general postoperative care, including activity and lifting restrictions, driving, and pain management. There would be no need to teach the signs or symptoms of rejection as there has been no transplant. Increased fluid intake is not normally recommended and the patient has minimal control on the future risk for metastasis.