Nokea
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.
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The nurse is assessing a patient who is receiving peritoneal dialysis with 2 L inflows. Which of the following information should be reported immediately to the health care provider?
- A. The patient has an outflow volume of 1800 mL.
- B. The patient's peritoneal effluent appears cloudy.
- C. The patient has abdominal pain during the inflow phase.
- D. The patient complains of feeling bloated after the inflow.
Correct Answer: B
Rationale: Cloudy appearing peritoneal effluent is a sign of peritonitis and should be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
Which of the following information is most useful to the nurse in evaluating improvement in kidney function for a patient who is hospitalized with acute kidney injury (AKI)?
- A. Blood urea nitrogen (BUN) level
- B. Urine output
- C. Creatinine level
- D. Calculated glomerular filtration rate (GFR)
Correct Answer: D
Rationale: GFR is the preferred method for evaluating kidney function. BUN levels can fluctuate based on factors such as fluid volume status. Urine output can be normal or high in patients with AKI and does not accurately reflect kidney function. Creatinine alone is not an accurate reflection of renal function.
The nurse is caring for a patient with chronic kidney disease (CKD) who is prescribed calcium carbonate. Which of the following parameters should the nurse assess in order to determine the effectiveness of the treatment?
- A. Blood pressure
- B. Phosphate level
- C. Neurological status
- D. Creatinine clearance
Correct Answer: B
Rationale: Calcium carbonate is prescribed to bind phosphorus and prevent mineral and bone disease in patients with CKD. The other data will not be helpful in evaluating the effectiveness of calcium carbonate.
The nurse is caring for a patient with acute kidney injury who is dehydrated with symptoms of oliguria, anemia, and hyperkalemia. Which of the following prescribed actions should the nurse take first?
- A. Insert a urinary retention catheter.
- B. Place the patient on a cardiac monitor.
- C. Administer an erythropoiesis-stimulating agent (ESA).
- D. Give sodium polystyrene sulfonate.
Correct Answer: B
Rationale: Since hyperkalemia can cause fatal cardiac dysrhythmias, the initial action should be to monitor the cardiac rhythm. ESA's will take time to correct the hyperkalemia and anemia. The catheter allows monitoring of the urine output but does not correct the cause of the renal failure.
Which of the following assessments should the nurse complete before administering sodium polystyrene sulphonate to a patient with hyperkalemia?
- A. Blood urea nitrogen (BUN) and creatinine
- B. Blood glucose level
- C. Patient's bowel sounds
- D. Level of consciousness (LOC)
Correct Answer: C
Rationale: Sodium polystyrene sulphonate should not be given to a patient who does not have normal bowel function because bowel necrosis can occur. The BUN and creatinine, blood glucose, and LOC would not affect the nurse's decision to give the medication.