Nokea
After noting lengthening QRS intervals in a patient with acute kidney injury (AKI), which of the following actions should the nurse take first?
- A. Document the QRS interval.
- B. Notify the patient's health care provider.
- C. Look at the patient's current blood urea nitrogen (BUN) and creatinine levels.
- D. Check the patient's most recent blood potassium level.
Correct Answer: D
Rationale: The increasing QRS interval is suggestive of hyperkalemia, so the nurse should check the most recent potassium and then notify the patient's health care provider. The BUN and creatinine will be elevated in a patient with AKI, but they would not directly affect the electrocardiogram (ECG). Documentation of the QRS interval also is appropriate, but interventions to decrease the potassium level are needed to prevent life-threatening bradycardia.
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The nurse is assessing a patient who had a kidney transplant 8 years ago and is receiving the immunosuppressants tacrolimus, cyclosporin, and prednisone. Which of the following findings is of most concern to the nurse?
- A. The blood glucose is 7.9 mmol/L.
- B. The patient's blood pressure is 150/92.
- C. There is a nontender lump in the axilla
- D. The patient has a round, moonlike face.
Correct Answer: C
Rationale: A nontender lump suggests a malignancy such as a lymphoma, which could occur as a result of persistent immunosuppressive therapy. The elevated glucose, moon face, and hypertension are possible adverse effects of the prednisone and should be addressed, but they are not as great a concern as the possibility of a malignancy.
The nurse is caring for a patient with severe heart failure who develops elevated blood urea nitrogen (BUN) and creatinine levels. The nurse will plan care to meet which of the following goals of treatment?
- A. Replace fluid volume
- B. Prevent hypertension.
- C. Maintain cardiac output.
- D. Dilute nephrotoxic substances.
Correct Answer: C
Rationale: The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient's heart failure is causing AKI, the care will be directed toward treatment of the heart failure. For renal failure caused by hypertension, hypovolemia, or nephrotoxins, the other responses would be correct.
The nurse is caring for a patient with diabetes who has been admitted with pneumonia and is prescribed gentamicin 60 mg IV. Which of the following parameters should the nurse monitor to evaluate the patient for adverse effects of the medication?
- A. Urine osmolality
- B. Serum potassium and sodium
- C. Blood glucose level
- D. Blood urea nitrogen (BUN) and creatinine
Correct Answer: D
Rationale: When a patient at risk for chronic kidney disease (CKD) receives a nephrotoxic medication, it is important to monitor renal function with BUN and creatinine levels. The other laboratory values would not be useful in determining the effect of the gentamicin.
The nurse is caring for a patient who has had progressive chronic kidney disease (CKD) for several years and is starting hemodialysis. Which of the following information about diet should the nurse include in patient teaching?
- A. Increased calories are needed because glucose is lost during hemodialysis.
- B. Unlimited fluids are allowed since retained fluid is removed during dialysis.
- C. More protein will be allowed because of the removal of urea and creatinine by dialysis.
- D. Dietary sodium and potassium are unrestricted because these levels are normalized by dialysis.
Correct Answer: C
Rationale: Once the patient is started on dialysis and nitrogenous wastes are removed, there is less protein lost, therefore more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.
The nurse is caring for a patient with hypertension and stage 2 chronic kidney disease (CKD) who is prescribed ramipril. Which of the following laboratory tests should the nurse assess before administration of the medication?
- A. Glucose
- B. Potassium
- C. Creatinine
- D. Phosphate
Correct Answer: B
Rationale: Angiotensin-converting enzyme (ACE) inhibitors are frequently used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect whether the ramipril was given or not.